290.2 🩺 國考版

290.2.1 高頻考點

290.2.1.1 Tumor Frequency

  • Metastatic > primary (20-40x)
  • Primary benign > malignant (75% vs 25%)
  • Myxoma is #1 primary benign
  • Angiosarcoma is #1 primary malignant

290.2.1.2 Myxoma Triad

  • Obstructive symptoms (HF, syncope, “tumor plop”)
  • Embolic phenomena (50% to brain)
  • Constitutional symptoms (fever, weight loss, ↑ ESR)

290.2.1.3 Carney Complex

  • PRKAR1A mutation, autosomal dominant
  • Multiple myxomas, pigmented lesions, endocrine tumors
  • NAME syndrome: Nevi, Atrial myxoma, Myxoid neurofibroma, Ephelides
  • LAMB syndrome: Lentigines, Atrial myxoma, Blue nevi

290.2.1.4 Tuberous Sclerosis + Cardiac

  • Rhabdomyoma in > 50% of TS patients
  • TSC1/TSC2 mutation
  • Multiple, ventricular
  • Often regresses; mTOR inhibitor (everolimus) for symptomatic

290.2.1.5 Imaging Modalities

  • Echo (TTE/TEE): first-line
  • CMR: tissue characterization (T1, T2, LGE, perfusion)
  • PET-CT: benign vs malignant (FDG avidity)
  • CT: calcifications (fibroma)

290.2.1.6 Most Common Tumor at Each Site

  • LA: myxoma
  • RA: angiosarcoma (malignant)
  • Valves: papillary fibroelastoma
  • Ventricular (children): rhabdomyoma, fibroma
  • Pericardium: metastatic, primary lymphoma

290.2.1.7 Tumor Behavior

  • Mobile + pedunculated: myxoma, fibroelastoma
  • Invasive + ill-defined: angiosarcoma, metastases
  • Multiple: tuberous sclerosis (rhabdomyoma), metastatic
  • Calcified: fibroma, calcified myxoma

290.2.2 易混淆比范

Tumor Most Common Site Demographics Imaging Hallmark Treatment
Myxoma LA fossa ovalis F adults T2 hyper, mobile Surgical excision
Papillary fibroelastoma Aortic valve Adults Small, frond-like Excision if symptomatic
Lipoma LA / subepicard Adults T1 hyper (fat) Excision if symptomatic
Rhabdomyoma Ventricles Children, TS Multiple, calcified mTOR / observation
Fibroma Ventricular Children Calcified Surgery
Angiosarcoma RA 30-50 yo Heterogeneous, vascular Surgery + chemo
Metastatic Pericardium Cancer hx Pericardial effusion Treat primary

290.2.3 Special Topics

290.2.3.1 Tumor vs Thrombus on Imaging

  • Thrombus: non-enhancing on CMR, no FDG
  • Tumor: enhances, ± FDG (malignant)
  • AC trial helpful in atypical cases

290.2.3.2 Genetic Syndromes + Cardiac Tumors

  • Carney complex (PRKAR1A) → myxoma
  • Tuberous sclerosis (TSC1/2) → rhabdomyoma
  • Gorlin syndrome → fibroma
  • NF1 → neurofibroma (rare cardiac)
  • Beckwith-Wiedemann → rhabdomyoma