Primary Cardiac Neoplasms Workup

Updated: Mar 06, 2019
  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Eric H Yang, MD  more...
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Laboratory Studies

Erythrocyte sedimentation rate (ESR) is a nonspecific test for which results may be elevated in the presence of a cardiac tumor.


Imaging Studies

See the list below:

  • Chest radiograph may demonstrate an enlarged cardiac silhouette or atrial enlargement.

  • MRI of the chest will demonstrate intracardiac pathology in the form of a mass. [15, 16]

  • Transesophageal echocardiography (TEE) is the test of choice. [17, 18] TEE delineates the position of the tumor and details the integrity or involvement of the septal and valvular structures. (Seventy-five percent of cardiac myxomas arise from the fossa ovalis on the left atrial side. [19] )

  • Perform fetal ultrasonography if the diagnosis is suspected in utero.

  • Cardiac catheterization is necessary only if other processes are strongly suspected.

  • Perform metaiodobenzylguanidine (MIBG) radionuclide scan for suspected paraganglioma. This scan uses a radioactive guanidine that is taken up preferentially by neuroendocrine cells.


Other Tests

ECG is ordered to detect potential arrhythmias that may be associated with tumors. These arrhythmias include atrial fibrillation, paroxysmal atrial tachycardia, and ventricular arrhythmias.


Histologic Findings

Myxomas are gelatinous in nature with rests of spindle cells (see the images below). [20]

Low-power photomicrograph of cardiac myxoma (hemat Low-power photomicrograph of cardiac myxoma (hematoxylin and eosin stain).
High-power photomicrograph showing the histology o High-power photomicrograph showing the histology of cardiac myxoma (hematoxylin and eosin stain). Note the dark staining polygonal cells characteristic of the tumor.

If DNA tetraploidy is present, suspect malignancy. Fibroelastomas are composed of endocardium, fibrous tissue, elastic fibers, and smooth muscle cells arranged in a central stock of collagen and a covering of hyperplastic endothelial cells.



No particular staging exists for cardiac tumors. The TNM nomenclature for primary cardiac tumors is not applicable due to their behavior and rarity. For metastatic disease to the heart, it is clear that M staging is appropriate.