Tumours of the heart
- Lesion
Tumours that start in the heart are rare. Most are benign myxomas in the left atrium; tumours spreading from elsewhere are more common.
What it is
Metastases to the heart and pericardium are far more common than primary cardiac tumours. Among primary tumours, the commonest in adults is the myxoma, usually a pedunculated mass in the left atrium attached at the fossa ovalis. Papillary fibroelastomas are frond-like lesions on valves that can embolise. Rhabdomyomas are the commonest cardiac tumour of infants and children, often with tuberous sclerosis, and many regress. Fibromas and lipomas are less common; angiosarcoma is the commonest primary malignant cardiac tumour. Metastases come mainly from lung and breast carcinomas, melanoma, lymphomas and leukaemias.
Structure
- Myxoma: soft, gelatinous, often lobulated or villous mass on a stalk; microscopy shows stellate or globular myxoma cells forming rings around vessels, in an acid mucopolysaccharide matrix.
Primary cardiac tumours and metastases
| Tumour | Who and where | Pathology | Problem |
|---|---|---|---|
| Myxoma | Adults; left atrium at the fossa ovalis | Stellate cells in abundant myxoid matrix, haemorrhage | Ball-valve obstruction, emboli, constitutional symptoms |
| Papillary fibroelastoma | Older adults; valve surfaces | Avascular fronds with collagen core and endothelial cover | Embolism |
| Rhabdomyoma | Infants and children; ventricles | Large vacuolated myocytes with ‘spider cells’ (glycogen) | Obstruction, arrhythmia; tuberous sclerosis |
| Fibroma | Children; ventricular septum | Fibroblasts and collagen | Arrhythmia; Gorlin syndrome |
| Lipoma and lipomatous hypertrophy | Adults; atrial septum | Mature fat | Usually none; atrial arrhythmia |
| Angiosarcoma and other sarcomas | Adults; right atrium | Malignant vascular channels | Effusion, obstruction, metastasis |
| Metastases | Lung, breast, melanoma, lymphoma, leukaemia | Usually pericardial, also myocardial | Effusion, tamponade, arrhythmia |
Clinical notes
- A myxoma can cause positional syncope, a ‘tumour plop’ sound, or a stroke in a young person; surgical removal is curative.
Test yourself
Think of the answer, then tap the question to see it.
What is the commonest primary cardiac tumour in adults, and where does it usually arise?
The myxoma, usually in the left atrium near the fossa ovalis.
Which cardiac tumour is associated with tuberous sclerosis?
The rhabdomyoma.
Are primary cardiac tumours more common than metastases to the heart?
No; metastases (from lung, breast, melanoma, lymphoma and leukaemia) are far more common.
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Heart Diseases | Cardiac Diseases | MedlinePlus (MedlinePlus, US National Library of Medicine, 2025); Tuberous sclerosis complex: MedlinePlus Genetics (MedlinePlus, US National Library of Medicine, 2025).
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Representative model, for educational purposes only.