An Overview of Cardiac Tumors in Mexico · 2019. 2. 11. · article distributed under the Creative...

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Clinics in Oncology

2019 | Volume 4 | Article 15611

An Overview of Cardiac Tumors in Mexico

OPEN ACCESS

*Correspondence:Nilda Espinola-Zavaleta, Nilda

Espinola-Zavaleta, Department of Nuclear Cardiology, National Institute

of Cardiology Ignacio Chavez, Mexico City, Mexico,

Department of Echocardiography, ABC Medical Center, I.A.P, Mexico City,

Mexico,E-mail: [email protected]

Received Date: 02 Dec 2018Accepted Date: 02 Jan 2019Published Date: 09 Jan 2019

Citation: Rico-Ramírez O, Aranda-Fraustro

A, Meave-Gonzalez A, Keirns C, Alexanderson-Rosas E, Espinola-

Zavaleta N. An Overview of Cardiac Tumors in Mexico. Clin Oncol. 2019; 4:

1561.

Copyright © 2019 Nilda Espinola-Zavaleta. This is an open access

article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution,

and reproduction in any medium, provided the original work is properly

cited.

Research ArticlePublished: 09 Jan, 2019

IntroductionCardiac tumors are very rare. They represent 0.002% to 0.2% of all tumors [1] and are of the

least studied in oncology [2]. These tumors are classified on the basis of their histology as primary benign or malignant tumors that originate in the heart and secondary metastatic tumors, which invade the heart [3]. In post-mortem studies primary cardiac tumors have an incidence of 0.05% [4]. Secondary tumors are found more frequently-1% in post-mortem studies-generally in the context of widely disseminated malignant disease [5]. They are usually diagnosed between the third and fifth decade of life [1,6]. While they are sometimes asymptomatic, they have been called the great simulators because of their tendency to manifest as any cardiac symptom, including shortness of breath, chest pain and palpitations [1-7]. Often signs and symptoms of cardiomyopathy, pericardial disease, systemic thromboembolism, and pulmonary thromboembolism, obstruction of a heart valve or chamber, or rhythm anomalies occur [7-12]. Tumors of the heart cause symptoms by three mechanisms: 1) intracardiac obstruction, 2) systemic embolization of tumor fragments or 3) constitutional symptoms from mechanisms that warrant further study [1,3,9].

At present, diagnosis is established based on clinical findings and non-invasive imaging techniques such as echocardiography [1-10], Cardiovascular Magnetic Resonance (CMR) and computed tomography [9,10].

The objective of this report is to provide an overview of cardiac tumors in Mexico as examined

AbstractBackground: Cardiac tumors account for 0.002% to 0.2% of all tumors. At present, the diagnosis is made on clinical data and non-invasive imaging methods. The aim of this study was to present an overview of cardiac tumors in Mexico compared to reference data.

Methods and Results: The clinical and pathological records of 238 cases of cardiac tumors from 1983 through 2017 were reviewed. Of these 21 were excluded because of incomplete information. From the study population of 217 it was possible to follow 156. All patients underwent transthoracic echocardiography.

One hundred-forty-six (93.6%) cardiac tumors were primary: 127(87%) benign and 19(13%) malignant. Two thirds of these were myxomas and one-twentieth rhabdomyomas. Secondary or metastatic cardiac tumors represented 6.4%.

Sixty nine percent of all cardiac tumors were found in female patients. The most frequent location was left atrium (63%). Eighty-one patients (52%) were asymptomatic. 79% underwent surgical treatment, 8.3% received only medical treatment and 12.8% received no treatment. The surgical survival of the final group was 78.9%. Fifteen (9.7%) died during follow-up. In the survival curve based on tumor type, the myxomas had the longest survival.

Conclusion: This population represents an overview of cardiac tumors in Mexico, compared to reference data. Cardiac tumors were more frequent in women with a female/male ratio of 2.19 to 1.0, and a predominance of primary cardiac tumors was found.

Keywords: Cardiac tumors; Pathology; Epidemiology; Echocardiography; Retrospective study

Ossiel Rico-Ramírez1, Alberto Aranda-Fraustro2, Aloha Meave-Gonzalez3, Candace Keirns4, Erick Alexanderson-Rosas5 and Nilda Espinola-Zavaleta5,6*1Department of Medicine, Autonomous University of Ciudad Juarez, Mexico

2Department of Pathology, National Institute of Cardiology Ignacio Chavez, Mexico

3Department of Magnetic Resonance imaging, National Institute of Cardiology Ignacio Chavez, Mexico

4Certified Medical Interpreter, N.B.C.M.I., USA

5Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico

6Department of Echocardiography, ABC Medical Center, I.A.P, Mexico

Nilda Espinola-Zavaleta, et al., Clinics in Oncology - General Oncology

Remedy Publications LLC., | http://clinicsinoncology.com/ 2019 | Volume 4 | Article 15612

in one of the principal concentration hospitals and compared to reference data (NIH).

Material and MethodsThis was a descriptive and retrospective study that analyzed the

records of 238 cases from the Department of Pathology reported as “cardiac tumor” or “neoplasia” over the period from January of 1983 to July of 2017. All patients were referred to the Instituto Nacional de Cardiologia Ignacio Chavez (INCICH) in Mexico City with clinical suspicion of a cardiac neoplasia and in whom the echocardiographic study corroborated the presence of a cardiac mass. Patients with incomplete hospital records or diagnosis of cardiac tumors not confirmed by histopathological study were excluded. The remaining 217 formed the study population. No follow-up was available for 61 patients, leaving 156 (Figure 1).

The records of these patients were reviewed, and the histopathological characteristics and dimensions of cardiac tumors from the anatomical studies were evaluated. The treatment of all patients was investigated and all of them were followed for the length of time reflected in the records.

Transthoracic Echocardiography (TTE) was performed on all of the patients as the initial diagnostic procedure. As of 2003 some patients also underwent computed magnetic resonance imaging.

Computed tomography was used when malignancy of the tumor and metastatic dissemination was suspected. All methods were carried out in accordance with relevant guidelines and regulations.

Pathological anatomy and histologySamples labeled cardiac tumors fixed in 10% formalin were

received. Cuts were made to further the fixation process, and subsequently specimens were photographed. Representative samples were taken, embedded in paraffin and sliced with a microtome to a thickness of 3 microns. The basic stain was hematoxylin-eosin with Masson, PAS, elastic fiber and silver stains used as required. In order to characterize tumors, Immunohistochemical techniques, including antibodies against specific muscular actin and smooth muscle actin, as well as smooth muscle markers, CD-34 and factor 8 as vascular markers and desmin as a marker for striated muscle were used on

Figure 1: Flow-chart shows the process of analysis of the patients included in the study.

Figure 2: Prevalence of cardiac tumors according to gender.

Figure 3a: Four chamber images taken by angiotomography (A) and magnetic resonance (B) showing a multilobulated mass mainly adhering to the left atrial inferior wall with infiltration into the left inferior pulmonary vein, anterior mitral leaflet and mitral-aortic junction. In the angiotomographic image the mass is seen as multilobulated and low density, while the cardiovascular magnetic resonance is hyperintense in T2 with significant reinforcement of the heterogeneous component when contrast medium is used. RA: Right Atrium; RV: Right Ventricle; LV: Left Ventricle.

Figure 3b: Macroscopic appearance of three ovoid specimens of tissue (6 cm × 4 cm × 3 cm). The surface is pale pink with yellow-brown and red-brown areas that appear to be hemorrhagic (A). Interior appearance of the specimens. One is red-black, the second yellow-brown and the last pale pink, corresponding to hemorrhagic areas, adipose-rich tissue and fibrous tissue, respectively (B). Microscopic images show a malignant tumor of mesenchymal origin. There are areas with malignant giant multinucleated cells; the nuclear pleomorphism corresponds to a maximum degree of anaplasia. (C): H/E 10X; (D): H/E 40X. In the differentiated portion adipose tissue is in the process of malignant transformation with dysplasia and neoplasia characterized by large nuclei with irregular chromatin and hyperchromatic nuclei affecting adipocytes. (E): H/E 10X; (F): H/E 40X. The adipose origin of the mass can be identified by the differentiated area, but the poorly differentiated and anaplastic areas can be categorized as pleomorphic liposarcoma.



some samples. All antibodies came from Dako, and the dilutions of each followed the recommendations of the provider.

Transthoracic and transesophageal echocardiographyAll patients underwent transthoracic echo and when there was

doubt, they were followed by transesophageal echocardiograms. Hewlett Packard IE33 equipment with a matrix-array transducer capable of M-mode, two dimensional, pulsed and continuous wave and color Doppler, tissue Doppler and three-dimensional modalities was used. Images of all the conventional sections were obtained, including parasternal short and long axis and apical 5, 4, 3 and 2 chamber images. The location, size, morphological characteristics, infiltration into other chambers and valvular obstruction of the masses were evaluated. Associated heart defects and pericardial effusion were sought, and ventricular function was evaluated in all patients.

ResultsOne hundred-forty-six (93.6%) cardiac tumors were primary:

127(87%) benign and 19(13%) malignant. In our series, 81.4% of the tumors analyzed were histologically benign. Two thirds of these were myxomas and one-twentieth rhabdomyomas. Six tumors in the left ventricle and five in the right ventricle corresponded to pediatric

patients diagnosed with tuberous sclerosis. Secondary or metastatic cardiac tumors represented 6.4%. As respects characteristics of the patients, female patients predominated with 69% of the total number of cardiac tumors, Figure 2. The median of follow-up of the total group was 1 year with a range of 1 day to 28 years. The most frequent location of tumors was the left atrium (63%), followed by the right atrium (19.7%), (Figures 3,4). Eighty-one of the 156 patients (52%) were asymptomatic. In patients with persistent clinical manifestations, shortness of breath, which occurred in 29%, was the most common symptom, followed by palpitations in 10% (Table 1).

In terms of treatment, 79% (n=123) underwent surgery, 8.3% (n=13) received only medical treatment, and 12.8% (n=20) without treatment (Table 1). Survival dependent on the surgical treatment was 78.9%. Fifteen patients (9.7%) died during follow-up, ten with myxomas as a result of embolism and/or obstruction, 3 with malignant tumors, one with a metastatic tumor and one with a rhabdomyoma (Table 1). In Figure 5, survival according to the type of cardiac tumors is shown.

Table 2 compares the patients of our series with the most important data of the literature as respects period of study, country of origin, distribution by gender, age, type and prevalence of tumors with confidence intervals (CI) of 95%.

DiscussionTumors of the heart have been considered rare clinical entities

that appear only sporadically. The prevalence of primary cardiac tumors reported in autopsies is 0.001% to 0.03% [13]. Prevalence of cardiac tumors is unknown in Mexico, although the incidence would appear to be 16% over a period of 16 years as has been reported in a population of patients from another Latin American concentration hospital [7]. In the present study, patients from different parts of the country were referred to our institution, which is the largest center of concentration for cardiovascular diseases in the country and one of the largest in Latin America. Inasmuch as our population was made up of patients referred to a concentration hospital, whether

Figure 4a: In the magnetic resonance image (A) a hyperintense intra pericardial lesion measuring 10 cm × 9 cm × 4.7 cm can be seen to compress the right ventricular free and inferior walls and the right atrial lateral wall that saturates fat suppression. The computed tomography (B) shows an intra pericardial mass with the density of fat.

Figure 4b: (A) Macroscopic appearance of an epicardial lipoma characteristically yellow, homogeneous and soft, measuring 6 cm × 4 cm × 3 cm and cut into 3 sections. (B) Microscopic section shows that the tumor is made up of mature adipocytes mixed with epicardial myocardiocytes, H/E 40X.

Figure 5: Survival of studied patients according to the type of cardiac tumors.



the findings are representative of the population as a whole could be called into question. It included a total of 238 patients with tumors of the heart in the 34-year period from 1983 to 2017, and the follow-up was made in 156 with a median follow-up of 1 year (minimum of 1 day and maximum of 28 years). The global prevalence was 0.142%, similar to those reported by Molina (USA) [8], Grande (Italy) [9], Yin (China) [10], Barreiro (Spain) [11] and Barnes (Australia) [12]. The only larger cohorts reported in the literature had follow-up periods of 48, [14] and 40 years [15].

Frequency of tumors according to genderIn our study, the cardiac tumors were more frequent in women

with a female/male ratio of 2.19 to 1.0, which is consistent with the literature [3,7,10,12,15-32]. The most frequent location of cardiac tumors was the left atrium, followed by the right atrium and the left ventricle [33-36]. In 22 studies of a review that included 32, tumors of the heart predominated in women with an average ratio of 1.92 and a range of 1.12 to 6.8 [3,7,10,12,15-32].

Predominance of primary cardiac tumorsIn our study, primary cardiac tumors predominated, which

is consistent with reports in the literature [3,7,10,12,15-32,37-42]. Primary cardiac tumors were benign in the 87% of cases, and myxomas represented 68% of all the tumors analyzed. In the survival curve according to tumor type, myxomas were found to have the longest survival in the follow-up.

Potential confounding factors in this study were age and gender. Two thirds of all cardiac tumors occurred in women, and primary tumors (myxomas) and metastases were the most frequent types. Myxomas predominated in the age group over 30 years, and the 100% of rhabdomyomas occurred in patients younger than 30 years old. The frequency of malignancy by age groups was similar; in patients 30 years old or less it was 28.5% and in those older than 30 it was 71.5%. This finding was very similar in the case of metastases to the heart: in the population under 30 years old it was of only 23% and in older patients 77%.

Leja et al. [43] reported that the primary cardiac tumors were benign in 75% of cases. Of these, half were myxomas, followed by

lipomas and papillary fibroelastomas. Vascular tumors such as hemangiomas, lymphangiomas and hemangioendotheliomas had a frequency of less than 10%. The other 25% of primary tumors of the heart were malignant tumors such as sarcomas and lymphomas.

Tumors of the heart tend to be asymptomatic and to be discovered by chance. Our experience was consistent with the literature [3,9,12,37,44]; more than half of the patients in our series were asymptomatic.

Despite the low rate of mortality reported for myxomas, in our cohort some cases required urgent surgery because of obstruction, which increased the mortality rate. Cardiac rhabdomyomas are the tumors most frequently found in children. Up to 80% of them have been reported in infants less than a year old, while they may be discovered in only about 20% of adult patients with tuberous sclerosis [45]. In our series, rhabdomyoma was the most common benign tumor in infants, a finding similar to reports in the literature. Likewise, 7 of the 11 rhabdomyomas occurred in patients with tuberous sclerosis, a finding frequently reported in carriers of this phacomatosis. Tuberous sclerosis is a hereditary multiorgan disease with an incidence of approximately 1 per 5,000 to 10,000 live births. It is an autosomal dominant neurocutaneous abnormality characterized by tumors that affect numerous organs, including brain, heart, kidneys and skin [46,47].

Malignant tumors represent around 8.9% of the total number of tumors. Sarcomas were the most common and had a mortality of 11%. The mortality of rhabdomyomas and metastatic tumors was 12.5% and 10%, respectively; these malignant entities accounted for higher mortality than the other tumors in our study.

Metastases are tumors that may originate in lung, breast and the gastrointestinal tract, from melanomas, Hodgkin’s disease, non-Hodgkin’s lymphoma, and extracardiac sarcomas [44]. According to the literature, the incidence of metastatic invasion of the heart is approximately 20 times more frequent than the incidence of primary tumors of the heart. Our findings, however, demonstrate the reverse, with a higher incidence of primary tumors and only 6.5% of cases with cardiac metastases. This finding could certainly have been affected by

Myxoma Rhabdomyoma Papillary fibroelastoma Lipoma Other benign

tumors Malignant Metastasis Total n=156 %

n=106 (68) n=8 (5.1) n=3 (1.9) n=1 (0.64) n=9 (5.7) n=19 (12.2) n=10 (6.5)

Age(Years) 45 (6-71) (5 months 1day-30) 63 (62-69) 43 50 (3-66) 41 (5-73) 46 (17-71)

Symptoms

Asymptomatic 61 (39) 5 (3.2) 2 (1.2) 2 (1.2) 2 (1.2) 4 (2.5) 5 (3.2) 81 52

Palpitations 11 (7) 2 (1.2) 1 (0.64) 0 (0) 0 (0) 1 (0.64) 0 (0) 15 10

Constitutional 7 (4.5) 0 (0) 0 (0) 0 (0) 0 (0) 2 (1.2) 1 (0.64) 10 6

Ventricular tachycardia 0 (0) 1 (0.64) 0 (0) 0 (0) 1 (0.64) 1 (0.64) 1 (0.64) 4 2.5

Dyspnea 27 (17) 0 (0) 1 (0.64) 1 (0.64) 2 (1.2) 11 (7) 4 (2.5) 46 29

Survival

Alive 96 (61.6) 7 (4.5) 3 (2) 1 (0.64) 9 (5.7) 16 (10.2) 9 (5.7) 141 90.3

Deceased 10 (6.4) 1 (0.64) 0 (0) 0 (0) 0 (0) 3 (2) 1 (0.64) 15 9.7

Treatment

Surgical 96 (61.6) 2 (1.2) 2 (1.2) 1 (0.64) 3 (2) 13 (8.3) 6 (4) 123 78.9

Medical 2 (1.2) 0 (0) 0 (0) 0 (0) 2 (1.2) 5 (3.2) 4 (2.5) 13 8.3

None 8 (5) 6 (4) 2 (1.2) 2 (1.2) 1 (0.64) 1 (0.64) 0 (0) 20 12.8

Table 1: Frequency of symptoms, type of treatment and survival of studied patients, n=156.



Author/Journal Period Country Gender M/F Age Type of tumors Prevalence CI (95%)

Dein JR J Thorac Cardiovasc Surg. 1987 1981-1986 Palo alto, USA

42

47 (8-79)

27 Myxomas

0.19 (0.072-0.30)15 /27 7 Benign non-myxomatous

8 Malignant

Molina JE Thorac Cardiovasc Surg. 1990 1959-1989 Minnesota, USA 124 47(13-85)

103 Benign 0.16 (0.103-0.235)

21 Malignant

Tazelaar HD Mayo Clinic Proc. 1992 1957-1991 Rochester

Minnesota, USA106

(2-80)98 Benign (78 Myxomas)

0.075 (0.025-0.126)39 /67 8 Malignant

Murphy MC Ann Thorac Surg 1990 1964-1989 Houston, Texas,

USA

133

3 dias-81 años

102 Benign

0.105 (0.049-0.162)58/75 12 Malignant

19 Metastatic

Dapper F Thorac Cardiovasc Surg.1988 1981-1987 Germany 48 (21-71)

39 Benign

0.18 (0.077-0.298)9 Malignant

>common left side

Mkalaluh S Med Sci Monit. 2017 1998-2016 Germany

16256.6 ± 17.6

126 Benign (102 Myxomas)0.22 (0.12-0.31)

67/95 36 Malignant

Hoffmeier A Thorac Cardiovasc Surg. 2005 1989-2004 Germany

108

45± 20

84 Benign (78 Myxomas)

0.106 (0.0444-0.169)67/41 10 Malignant primary

8 Metastatic

6 Renal cell tumors with cardiac involvement

Bossert T Interac Thorac surgery 2005 1994-2003 Germany

77

73 Benign0.052 (0.002-0,102)

25/48 4 Malignant

Agaimy A Cardiovasc Pathol. 2012 2001-2011 Germany

84

60 (20-84)

62 Primary (59 Benign, 3 Malignant)

0.068 (0.010-0.125)28/56 9 Metastatic

13 Cardiac thrombus

Bauer EP Schweiz Med Wochenschr. 1991 1968-1990 Germany

51 49 46 Benign (41 Myxomas)0.09 (0.030- 0,11)

24/27 7m-76 años 5 Malignant

Basso C Eur J Cardiothorac Surg 1997. 1970-1995 Italy

12551(6-78)

113 Benign0.079 (0.029-0.129)

53/72 12 Malignant

Grande AM Tex Heart Inst J 1993 1980-1992 Italy 31 71 (41 ±18)

26 Benign0.161 (0.032-0.291)

5 Malignant

Centofanti C Ann Thorac Surg. 1999 1980-1997 Italy.

9155±13

86 Benign (83 Myxomas)0.055 (0.008-0.102)

29 /54 5 Malignant

Dell’amore A G Chir. 2013 1992-2012 Italy

91 48 ± 7 85 Benign (63 Myxomas, 22 Papillary fibroelastoma)

0.044 (0.002-0.086)32/59 4 Malignant

2 Other benign tumors

Padalino MA Circulation. 2012 1990-2005 Italy

89 4.3 months 93 Benign0.067 (0.015-0.120)

41/48 (1 day-18 years) 6 Malignant

Miralles A Ann Thorac Surg 1991 1972-1989 France 75 48 (9-75)

73 Primary (58 Myxomas,7 Malignant)0.096 (0.028-0.163)

2 Metastatic

Blondeau P Thorac Cardiovasc Surg. 1990 1964-1989 France

533(2.5-82)

480 Primary (444 Myxomas) 0.099 (0.074-0.125)> involvement of

women 53 Malignant

Perchinsky MJ Cancer 1997 1956-1996 Vancouver,

Canada71

55 (18-83)57 Benign

0.197 (0.105-0.29)25/46 14 Malignant

Piazza N Can J Cardiol. 2004 1986-2003 Canada 21 (Newborn -76

years)

16 Myxomas

0.04 (0.001- 0.09)

2 Rhabdomyoma

1 Fibroma

1 Angiosarcoma

1 Synovial sarcoma

Table 2: Compilation of authors, study period, sex, and age, type of tumors and prevalence with CI of 95%.



Tschirkov A Thorac Cardiovasc Surgery 1990 1970-1988 Bulgaria.

63 50.4 62 Benign ( 57 Myxomas)0.016 (0.00-0.047)

48/15 (42.2-53.6) 1 Malignant

Moosdorf R Thorac Cardiovasc Surg. 1990 1964-1989 Bulgaria. 54 ??

42 Benign0.176 (0.072-0.281)

12 Malignant

Kamiya H Jpn Circ J. 2001 1973-2000 Japan 34

23 Myxomas: 22 left, 1 right

0.118 (0.009-0.226)7 Benign non-Myxomas

4 Malignant

Yu K Interact Cardiovasc Thorac Surg. 2007 1886-2005 Beijing China

242 45(4 months - 79 years)

234 Primary (212 Myxomas, 22 Malignant) 0.094 (0.057-0.131)

94/148 8 Metastatic

Yin L J Thorac Dis. 2016 2008-2013 Shanghai China

131

51.3 ± 16.3

104 Primary

0.168 (0.102-0.234)50/81 21 Malignant

6 MetastaticAgarwal V Indian Heart J 2003 1989-2001 Sanjay Gandhi,

India34 40 ±13 34 Primary (31 Myxomas, 3 Malignant) 0.059 (0.000-0138)16/18

Kumar N Pathol Res Pract. 2011 1995-2010 Ansari Nagar, New

Delhi, India

188

37 (3-72)

184 Primary

0.076 (0.038-0.255)24/164 (170 Benign: 168 Myxomas, 2 Fibroma, 14 Malignant)

4 Metastatic

Barreiro M Cardiovasc Patho 2013 1979-2012 Spain 73 61

62 Myxomas0.151 (0.069-0.233)

11 Malignant

Patel J 2009 Cardiovasc Pathol. 2010 1990-2008 London 94 (0-80)

67 Benign

27 Malignant 0.287 (0.196-0.379)Barnes H Asian Cardiovasc Thorac Ann. 2014

1990-2012 Melbourne, Australia.

30 57 26 Benign

20-Oct (32-59) 4 Malignant 0.133 (0.012-0.255)

Saraiva J Rev Port Cardiol. 2016 1994-2014 Coimbra, Portugal

12355 ± 16.9

111 Benign

41/82 12 Malignant 0.098 (0.045-0.150)

Habertheuer A J Cardiothorac Surg. 2015 1999-2014 Vienna

11357.9 ± 16.8

102 Benign

42/71 11 Malignant 0.097 (0.043-0.152)

Alfaro-Gomez F Cir Ciruj 2003 1987-2002 Mexico

5143 ±17

43 Benign

20/31 8 Malignant 0.15 (0.09-0.214)

Our study 2018 1983-2017 Mexico217

1day -79 years207 Primary (188 Benign,19 Malignant)

68/149 0.142 (0.04-0.21)

10 Metastatic

the fact that our patients were referred to a cardiac concentration hospital (INCICH), which would exclude the incidental discovery of cardiac metastases in the setting of malignant disease of other organ systems.

Global survival was 90.3% with no mortality for cases of lipomas, fibroelastomas or other benign tumors. In the final follow-up 15 of the patients (9.7%) had died.

Limitations: Technological advances in diagnostic modalities that occurred over the period of the study made comparative analysis of the cases difficult. Discontinuity of the hospital records over a long period of time also had an adverse effect on analysis.

This population represents an overview of cardiac tumors in Mexico, compared to reference data. The cardiac tumors in Mexico were more frequent in women with a female/male ratio of 2.19 to 1.0 with a clear predominance of primary cardiac tumors.

Clinical suspicion, non-invasive imaging techniques and better histological screening made early detection of tumors of the heart possible.

The incidence of cancer has led to better screening procedures and public health strategies that promise to have a favorable impact

on one of the principal causes of mortality in the next decades.

Key PointsCardiac tumors are rare, representing 0.142 (0.04-0.21) of all

tumors.

The cardiac tumors in Mexico were more frequent in women with a female/male ratio of 2.19 to 1.0 with a clear predominance of primary cardiac tumors. This is the largest series of tumors of the heart in Mexico and in Latin America with a 34-year follow-up.

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