SURGICAL PATHOLOGY OF PRIMARY CARDIAC AND PERICARDIAL TUMORS

Objective: Retrospective study of surgical pathology experience on car diac and pericardial tumors at the University of Padua in the era of i mmunohistochemistry and endomyocardial biopsy. Methods: In the period 1970-1995, we studied 125 bioptic primary neoplasms: specimens were ob tained from surgical resection in 116 cases, heart transplantation in 3, pericardiectomy in 3, endomyocardial biopsy in 2 and thoracoscopic biopsy in 1. Tumor histotype was established by light microscopy and m ore recently by immuno-histochemistry. using a large panel of antibodi es, through avidin-biotin peroxidase method, against factor VIII-relat ed antigen, ulex-europaeus, desmin, myoglobin, muscle-specific actin, smooth muscle-specific actin, vimentin, cytokeratins, leukocytic commo n antigen, neurofilaments and S100-protein. Results: One hundred and t hirteen were benign neoplasms: myxoma was the most frequent (87 cases) followed by pericardial cyst (8), endocardial papilloma (5), fibroma (3), rhabdomyoma (3), hematic cyst (2), teratoma (2), hemangioma (1), celothelioma (1) and lipoma (1). Malignancy was diagnosed in 12 cases. and consisted of pericardial mesothelioma (3), myxosarcoma (3), angio sarcoma (2), fibrosarcoma (2) and leiomyosarcoma (2); 4 of them were i ntracavitary atrial masses and were supposed to be atrial myxoma on th e clinical ground. Differential diagnosis included endocardial thrombo sis (10), metastasis of concealed extracardiac tumors (5), echinococco sis (3), and Loeffler's fibroplastic endocarditis (3). In 4 cases, car diac mass histotype was defined without thoracotomy, through endomyoca rdial (3) and thoracoscopic (I) biopsy. Conclusions: A large spectrum of cardiac tumors is observed in the surgical pathology practice. Alth ough the diagnosis of cardiac masses is easily attainable by routine i maging techniques, differential diagnosis between primary and secondar y tumors, malignant and benign forms, and non neoplastic masses, is ac hievable only by a thorough microscopic study of surgical resections. The role of the cardiac pathologist is becoming crucial as in other fi elds of oncology. (C) 1997 Elsevier Science B.V.