Rhabdomyoma

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Rhabdomyoma
Cardiac rhabdomyoma.jpg
Surgically excised cardiac rhabdomyoma (unfixed)
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A rhabdomyoma is a benign tumor of striated muscle. Rhabdomyomas may be either cardiac or extracardiac (occurring outside the heart). Extracardiac forms of rhabdomyoma are sub-classified into three distinct types: adult type, fetal type, and genital type.

Contents

Cardiac rhabdomyomas are the most common primary tumor of the heart in infants and children. It has an association with tuberous sclerosis. [1] In those with tuberous sclerosis, the tumor may regress and disappear completely, or remain consistent in size. [2] A common histological feature is the presence of spider cells, which are cardiac myocytes with enlarged glycogen vacuoles separated by eosinophilic strands, resembling the legs of a spider.

It is most commonly associated with the tongue, [3] and heart, [4] but can also occur in other locations, such as the vagina. [5]

Malignant skeletal muscle tumors are referred to as rhabdomyosarcoma. Only rare cases of possible malignant change have been reported in fetal rhabdomyoma. The differential diagnosis in the tongue includes ectomesenchymal chondromyxoid tumor. [6]

Cardiac Rhabdomyoma

It is much more common to find metastasis from an alternate site than a primary heart tumor. [7] However, primary cardiac tumors do occur. One of these is the cardiac rhabdomyoma. Approximately 80-90% of these tumors are found in patients with tuberous sclerosis, a genetic condition causing multiple tumors, with most found prior to the age of one. [8] Although these tumors are most commonly treated with resection, symptomatic tumors in fetuses have been shown to decrease in size after maternal sicrolimus administration. [9] If clinically silent, they can be watched with routine imaging as the tumor will likely spontaneously regress. [2]

Clinical Picture

The specific clinical picture of a patient with a cardiac rhabdomyoma is determined by its location in the heart. [10] However, if symptomatic, most patients will present with heart failure or an arrhythmia such as ventricular tachycardia or heart block. [11] The severity of the symptoms will vary based on the size of the mass.

Detection

Prenatal ultrasound showing fetal cardiac rhabdomyoma Fetal Cardiac Rhabdomyoma.png
Prenatal ultrasound showing fetal cardiac rhabdomyoma

Cardiac rhabdomyomas are usually found in the ventricular walls or on the valves of the heart. With imaging techniques such as ultrasound and magnetic resonance imaging (MRI), these tumors are being detected with increased frequency and even in the prenatal period. Routine surveillance of children with tuberous sclerosis for cardiac rhabdomyoma or other cardiovascular manifestations of their disease may include electrocardiogram (EKG) and echocardiography. [12]

Additional images

Photomicrograph of fetal-type rhabdomyoma: Note the plump, pink benign skeletal muscle cells. Fetal intermediate cellular type rhabdomyoma.JPG
Photomicrograph of fetal-type rhabdomyoma: Note the plump, pink benign skeletal muscle cells.

Related Research Articles

<span class="mw-page-title-main">Tuberous sclerosis</span> Genetic condition causing non-cancerous tumours

Tuberous sclerosis complex (TSC) is a rare multisystem autosomal dominant genetic disease that causes non-cancerous tumours to grow in the brain and on other vital organs such as the kidneys, heart, liver, eyes, lungs and skin. A combination of symptoms may include seizures, intellectual disability, developmental delay, behavioral problems, skin abnormalities, lung disease, and kidney disease.

<span class="mw-page-title-main">Myxoma</span> Myxoid tumor of primitive connective tissue

A myxoma is a myxoid tumor of primitive connective tissue. It is most commonly found in the heart but can also occur in other locations.

<span class="mw-page-title-main">Hydrops fetalis</span> Human disease of fetuses

Hydrops fetalis or hydrops foetalis is a condition in the fetus characterized by an accumulation of fluid, or edema, in at least two fetal compartments. By comparison, hydrops allantois or hydrops amnion is an accumulation of excessive fluid in the allantoic or amniotic space, respectively.

<span class="mw-page-title-main">Hamartoma</span> Tumour-like overgrowth due to a systemic genetic condition

A hamartoma is a mostly benign, local malformation of cells that resembles a neoplasm of local tissue but is usually due to an overgrowth of multiple aberrant cells, with a basis in a systemic genetic condition, rather than a growth descended from a single mutated cell (monoclonality), as would typically define a benign neoplasm/tumor. Despite this, many hamartomas are found to have clonal chromosomal aberrations that are acquired through somatic mutations, and on this basis the term hamartoma is sometimes considered synonymous with neoplasm. Hamartomas are by definition benign, slow-growing or self-limiting, though the underlying condition may still predispose the individual towards malignancies.

<span class="mw-page-title-main">Hemangioendothelioma</span> Medical condition

Hemangioendotheliomas are a family of vascular neoplasms of intermediate malignancy.

Phakomatoses, also known neurocutaneous syndromes, are a group of multisystemic diseases that most prominently affect structures primarily derived from the ectoderm such as the central nervous system, skin and eyes. The majority of phakomatoses are single-gene disorders that may be inherited in an autosomal dominant, autosomal recessive or X-linked pattern. Presentations may vary dramatically between patients with the same particular syndrome due to mosaicism, variable expressivity, and penetrance.

Sacrococcygeal teratoma (SCT) is a type of tumor known as a teratoma that develops at the base of the coccyx (tailbone) and is thought to be primarily derived from remnants of the primitive streak. Sacrococcygeal teratomas are benign 75% of the time, malignant 12% of the time, and the remainder are considered "immature teratomas" that share benign and malignant features. Benign sacrococcygeal teratomas are more likely to develop in younger children who are less than 5 months old, and older children are more likely to develop malignant sacrococcygeal teratomas.

<span class="mw-page-title-main">Persistent left superior vena cava</span> Medical condition

In anatomy, a persistent left superior vena cava is the most common variation of the thoracic venous system. It is present in between 0.3% and 0.5% of the population, and is an embryologic remnant that results from a failure to involute.

<span class="mw-page-title-main">Primary tumors of the heart</span> Medical condition

Primary tumors of the heart are extremely rare tumors that arise from the normal tissues that make up the heart. The incidence of primary cardiac tumors has been found to be approximately 0.02%. This is in contrast to secondary tumors of the heart, which are typically either metastatic from another part of the body, or infiltrate the heart via direct extension from the surrounding tissues. Metastatic tumors to the heart are about 20 times more common than primary cardiac tumors.

Heart cancer is an extremely rare form of cancer that is divided into primary tumors of the heart and secondary tumors of the heart.

<span class="mw-page-title-main">Myocardial rupture</span> Medical condition

Myocardial rupture is a laceration of the ventricles or atria of the heart, of the interatrial or interventricular septum, or of the papillary muscles. It is most commonly seen as a serious sequela of an acute myocardial infarction.

<span class="mw-page-title-main">Papillary fibroelastoma</span> Medical condition

A papillary fibroelastoma is a primary tumor of the heart that typically involves one of the valves of the heart. Papillary fibroelastomas, while considered uncommon, make up about 10 percent of all primary tumors of the heart. They are the third most common type of primary tumor of the heart, behind cardiac myxomas and cardiac lipomas.

Fetal echocardiography, or Fetal echocardiogram, is the name of the test used to diagnose cardiac conditions in the fetal stage. Cardiac defects are amongst the most common birth defects. Their diagnosis is important in the fetal stage as it might help provide an opportunity to plan and manage the baby as and when the baby is born. Not all pregnancies need to undergo fetal echo.

<span class="mw-page-title-main">Angiofibroma</span> Medical condition

Angiofibroma (AGF) is a descriptive term for a wide range of benign skin or mucous membrane lesions in which individuals have:

  1. benign papules, i.e. pinhead-sized elevations that lack visible evidence of containing fluid;
  2. nodules, i.e. small firm lumps usually >0.1 cm in diameter; and/or
  3. tumors, i.e. masses often regarded as ~0.8 cm or larger.
<span class="mw-page-title-main">Pacemaker syndrome</span> Medical condition

Pacemaker syndrome is a condition that represents the clinical consequences of suboptimal atrioventricular (AV) synchrony or AV dyssynchrony, regardless of the pacing mode, after pacemaker implantation. It is an iatrogenic disease—an adverse effect resulting from medical treatment—that is often underdiagnosed. In general, the symptoms of the syndrome are a combination of decreased cardiac output, loss of atrial contribution to ventricular filling, loss of total peripheral resistance response, and nonphysiologic pressure waves.

<span class="mw-page-title-main">Koenen's tumor</span> Medical condition

Koenen's tumor (KT), also commonly termed periungual angiofibroma, is a subtype of the angiofibromas. Angiofibromas are benign papule, nodule, and/or tumor lesions that are separated into various subtypes based primarily on the characteristic locations of their lesions. KTs are angiofibromas that develop in and under the toenails and/or fingernails. KTs were once considered as the same as another subtype of the angiofibromas viz., acral angiofibromas. While the literature may still sometimes regard KTs as acral angiofibromas, acral angiofibromas are characteristically located in areas close to but not in the toenails and fingernails as well as in the soles of the feet and palms of the hands. KTs are here regarded as distinct from acral angiofibromas.

Cardiac fibroma, also known as cardiac fibromatosis, cardiac fibrous hamartoma, fibroelastic hamartoma of heart and fibroma of heart is the second highest type of primary cardiac tumor seen in infants and children. This benign tumor made by connective tissue and fibroblast is largely observed in the ventricles of the heart. The left ventricle is the most common location of cardiac fibroma and accounts for approximately 57% of cardiac fibroma cases followed by the right ventricle with 27.5% of cases. Symptoms of the disease depend on the size of the tumor, its location relative to the conduction system, and whether it obstructs blood flow. Two-thirds of children with this tumor are asymptomatic, showing no signs and symptoms. Therefore the cause of cardiac fibroma is unexplained but has been associated with Gorlin Syndrome. Echocardiography is the primarily diagnostic method used to detect if an individual has cardiac fibroma. Resection of the tumor is recommended however heart transplantation is done if surgery is not possible. Overall prognosis of resection is favorable and the chance of recurrence is scarcely reported.

<span class="mw-page-title-main">Myoepithelioma of the head and neck</span> Medical condition

Myoepithelioma of the head and neck, also myoepithelioma, is a salivary gland tumour of the head and neck that is usually benign. When malignant, which is exceedingly rare, they are known as malignant myoepithelioma or Myoepithelial carcinoma, and they account for 1% of the salivary tumors with poor prognosis.

Rhabdomyoma is a benign mesenchymal tumor of skeletal muscle, separated into two major categories based on site: Cardiac and extracardiac. They are further separated by histology: fetal, juvenile (intermediate), and adult types. Genital types are recognized, but are often part of either the fetal or juvenile types. The fetal type is thought to recapitulate immature skeletal muscle at about week six to ten of gestational development.

<span class="mw-page-title-main">Ischemic cardiomyopathy</span> Medical condition

Ischemic cardiomyopathy is a type of cardiomyopathy caused by a narrowing of the coronary arteries which supply blood to the heart. Typically, patients with ischemic cardiomyopathy have a history of acute myocardial infarction, however, it may occur in patients with coronary artery disease, but without a past history of acute myocardial infarction. This cardiomyopathy is one of the leading causes of sudden cardiac death. The adjective ischemic means characteristic of, or accompanied by, ischemia — local anemia due to mechanical obstruction of the blood supply.

References

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  2. 1 2 Smythe, John F.; Dyck, John D.; Smallhorn, Jeffrey F.; Freedom, Robert M. (November 1990). "Natural history of cardiac rhabdomyoma in infancy and childhood". The American Journal of Cardiology. 66 (17): 1247–1249. doi:10.1016/0002-9149(90)91109-j. ISSN   0002-9149. PMID   2239731.
  3. Pérez-Alonso P, Sánchez-Simón R, Contreras F, Patrón-Romero M (December 2000). "Special feature: pathological case of the month. Denouement and discussion: fetal rhabdomyoma of the tongue (myxoid type)". Arch Pediatr Adolesc Med. 154 (12): 1265–6. doi: 10.1001/archpedi.154.12.1265 . PMID   11115314.
  4. Sugiyama H, Naito H, Tsukano S, Echigo S, Kamiya T (November 2005). "Evaluation of cardiac tumors in children by electron-beam computed tomography: rhabdomyoma and fibroma". Circ. J. 69 (11): 1352–6. doi: 10.1253/circj.69.1352 . PMID   16247210.
  5. Edward F. Goljan (2009). Pathology (Third ed.). Elsevier. p. 537. Tumour Type: Rhabdomyoma; Location: Heart, also tongue and vagina; Comment: Benign heart tumour associated with tuberous sclerosis
  6. Smith BC, Ellis GL, Meis-Kindblom JM, Williams SB (May 1995). "Ectomesenchymal chondromyxoid tumor of the anterior tongue. Nineteen cases of a new clinicopathologic entity". Am J Surg Pathol. 19 (5): 519–30. doi:10.1097/00000478-199505000-00003. PMID   7726361. S2CID   21161742.
  7. Salcedo, E (February 1992). "Cardiac tumors: Diagnosis and management". Current Problems in Cardiology. 17 (2): 77–137. doi:10.1016/0146-2806(92)90025-J. PMID   1735241.
  8. MDa, Maurice Beghetti; Gow, Robert M.; Haney, Isabel; Mawson, John; Williams, William G.; Freedom, Robert M. (December 1997). "Pediatric primary benign cardiac tumors: A 15-year review". American Heart Journal. 134 (6): 1107–1114. doi:10.1016/S0002-8703(97)70032-2. PMID   9424072.
  9. Duan, Menghao; Sundararaghavan, Sreekanthan; Koh, Ai Ling; Soh, Shui Yen (March 2022). "Neonatal rhabdomyoma with cardiac dysfunction: favourable response to sirolimus". BMJ Case Reports. 15 (3): e244915. doi:10.1136/bcr-2021-244915. ISSN   1757-790X. PMC   8948400 . PMID   35332001.
  10. Vander Salm, Thomas J. (April 2000). "Unusual Primary Tumors Of The Heart". Seminars in Thoracic and Cardiovascular Surgery. 12 (2): 89–100. doi:10.1053/ct.2000.5080. PMID   10807431.
  11. Jacobs, Jeffrey P.; Konstantakos, Anastasios K.; Holland, Fred W.; Herskowitz, Kenneth; Ferrer, Peter L.; Perryman, Richard A. (November 1994). "Surgical treatment for cardiac rhabdomyomas in children". The Annals of Thoracic Surgery. 58 (5): 1552–1555. doi: 10.1016/0003-4975(94)91963-1 . PMID   7979700.
  12. Northrup, Hope; Aronow, Mary E.; Bebin, E. Martina; Bissler, John; Darling, Thomas N.; de Vries, Petrus J.; Frost, Michael D.; Fuchs, Zoë; Gosnell, Elizabeth S.; Gupta, Nishant; Jansen, Anna C.; Jóźwiak, Sergiusz; Kingswood, J. Chris; Knilans, Timothy K.; McCormack, Francis X. (October 2021). "Updated International Tuberous Sclerosis Complex Diagnostic Criteria and Surveillance and Management Recommendations". Pediatric Neurology. 123: 50–66. doi: 10.1016/j.pediatrneurol.2021.07.011 . PMID   34399110.