Functional imaging in cardiac tumors

Primary cardiac neoplasms are rare and identified in 0.05–0.15 % of cases in large autopsy [1, 2] and echocardiography series [3]. Primary cardiac tumors may be classified as benign or malignant. The most common benign cardiac tumors include myxoma, rhabdomyoma, fibroma, and lipoma, whereas the most common malignant primary tumors are sarcomas (angiosarcoma, fibrosarcoma, undifferentiated sarcoma, rhabdomyosarcoma) and lymphoma [4, 5]. The majority, about three-fourth, of these tumors are benign [1, 2]. Secondary involvement of the heart or pericardium through local invasion or metastatic spread of malignant tumors is at least 20 times more common, identified in about 1.2 % of autopsy cases [1, 2] and 8 % of cancer victims [6]. Thoracic tumors (e.g., lung, breast, and esophagus) commonly invade the pericardium and heart. Other tumors that tend to metastasize to the heart include melanoma, soft tissue sarcomas, and gastric, pancreatic, thyroid, renal, and hepatocellular carcinomas [2, 6]. Cardiac involvement in lymphoma and leukemia is also common [2, 6]. When analyzed by the frequency according to the histologic type of the primary tumor, melanoma is the malignancy that more often metastasizes to the heart (46 % in autopsy series), followed by germ cell tumors (38 %), leukemia, and lymphoma [7].