Cardiovascular masses

Background

Cardiac neoplasms can be separated into primary or secondary and whilst the latter are more common, most surgical resections are for primary tumours.
The two most common benign cardiac masses are myxomas and papillary fibroelastomas.  Malignant primary cardiac tumours are rare but include pericardial mesotheliomas, lymphomas and sarcomas.1-5

Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

Fresh tissue received
  • No
    • Non-routine fixation (not formalin), describe.
  • Yes
    • Special studies required, describe.
    • Ensure samples are taken prior to fixation.
Intraoperative consultation
  • Not performed
  • Performed, describe type and result
    • Frozen section
    • Imprints
    • Other, describe

See general information for more detail on specimen handling procedures.

Inspect the specimen and dictate a macroscopic description.

External InspectionBack to top


Orientate and identify the anatomical features of the specimen; base of cardiac myxomas and cardiac attachments of other masses.

Orientation markers

Record additional orientation or designation provided by operating clinician:

  • Absent
  • Present
    • Method of designation (e.g. suture, incision)
    • Featured denoted

Procedure

Record as stated by the clinican

Options
  • Cardiac tumour resection
  • Other, specify

Specimen integrity

  • Intact
  • Disrupted

Anatomical components included (more than one may apply) and specimen dimensions (mm)

Describe and measure the anatomical components present. 

  • Total specimen, in three dimensions1
  • Specimen weight (g)1
  • Epicardium1
    • Absent
    • Present, measure in three dimensions
  • Endocardium1
    • Absent
    • Present, measure in three dimensions
  • Myocardium1
    • Absent
    • Present, measure in three dimensions
  • Any other identifiable normal structure(s) e.g. interatrial septum or valve1
  • For biopsy specimens, record the site and number of fragments, see protocol provided

Specimen description

  • Colour
  • Consistency
    • Gelatinous
    • Solid
    • Rubbery
  • Shape
  • Surface
    • Smooth
    • Rough
    • Villous
  • Type of growth
  • Presence of pedicle
  • Other, specify

Photograph the intact specimen if required.

Describe the following features of the specimen:

DissectionBack to top


Paint the surgical resection margins with ink. Serially section the specimen at 5mm intervals allowing evaluation of the margins.

Internal InspectionBack to top


Describe the cut surface appearance including the following items:

Tumour site (if known)

Options
  • Not specified
  • Right atrium
  • Left atrium
  • Right ventricle
  • Left ventricle
  • Ventricular septum
  • Atrial septum
  • Valve, specify
  • Great vessel, specify
  • Pericardium
  • Other submitted specimens, specify

Tumour focality

  • Indeterminate
  • Unifocal
  • Multifocal
    • Number of tumours
    • Location of each

Tumour description

For each tumour present, describe:
  • Appearance
    • Cystic degeneration
    • Calcification(s)
    • Necrosis
    • Haemorrhage
    • Colour
    • Other, specify
  • Describe any involvement of tumour with adjacent normal structures 1
  • Distance of tumour to margin(s) in mm

Tumour integrity

  • Indeterminate
  • Intact
  • Disrupted, describe

Tumour size

  • Primary tumour, in three dimensions
  • Other tumours or tumour-like lesions, in three dimensions

Photograph the dissected specimen, if required.

Note photographs taken, diagrams recorded and markings used for identification.

ProcessingBack to top


Submit representative sections of the specimen.

  • Sections perpendicular to the surgical margin(s). 1
  • At least one section per 10mm of tumour demonstrating the relationship with adjacent tissue 1
  • Sample any areas of necrosis and heterogeneity 1

Record details of each cassette.

An illustrated block key similar to the one provided may be useful.

Acknowledgements

Prof Tony Thomas for his contribution in reviewing and editing this protocol.

Block allocation key

Cassette id Site No. of pieces
A Surgical margin(s), perpendicular sections  
B-D Tumour, one section per 10mm, demonstration relationship with adjacent tissue  
E-F Heterogeneous and necrotic areas of tumour  

ReferencesBack to top


  1. Stone JR, Basso C, Baandrup UT, Bruneval P, et al. Recommendations for processing cardiovascular surgical pathology specimens: a consensus statement from the Standards and Definitions Committee of the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology. Cardiovasc Pathol. 2012;21(1):2-16.
  2. Sheppard MN, Mohiaddin R. Tumors of the heart. Future cardiology. 2010;6(2):181-93.
  3. Boyle JJ, Rassl DM, Neil D, Suvarna K and Doran H. Tissue Pathways for Cardiovascular Pathology, The Royal College of Pathologists, London, 2008.
  4. Sheppard M and Davies MJ. Tumours of the Heart. In: Practical Cardiovascular Pathology, Arnold, London, 1998.
  5. Burke A, Jeudy JJ and Virmani R. Cardiac tumours: an update: Cardiac tumours. Heart 2008;94:117-123.