USMLE® Step 1 style questions USMLE
A 15-year-old boy is being evaluated in the clinic after passing out in school during physical activity class. Medical history is significant for hyperactivity and behavioral problems since childhood. He often gets into fights, talks back to his teachers and has low performance in school. A recent IQ test evaluation was 71. Physical examination reveals a cardiac murmur. An echo is obtained and reveals a cardiac mass. Which of the following additional findings is most likely to be found on further evaluation of this patient?
Content Reviewers:Rishi Desai, MD, MPH
Contributors:Tanner Marshall, MS, Vincent Waldman, PhD
Cardiac tumors are abnormal growths of cells that form a mass in the heart. If the cell growth has the potential to invade and spread to other tissues — a process called metastasis — it’s a malignant tumor, more commonly known as a cancer. If it is not able to invade other tissues, it’s referred to as a benign tumor.
Now, the vast majority of tumors of the heart are actually secondary, meaning that a tumor developed somewhere else in the body, metastasized, and spread to the heart.
Even though these secondary tumors can come from anywhere, they’re most commonly metastases from lung cancer, lymphoma or lymphatic system cancer, breast cancer, leukemia or blood cell cancer, melanoma or skin cancer, hepatocellular carcinoma or liver cancer, and colon cancer, in this order. Cancer most commonly metastasizes through the lymphatic system to the pericardium, the membrane around the heart. When the pericardium is involved, it often leads to pericarditis, or inflammation of the pericardium, and pericardial effusion, an accumulation of fluid in the pericardial cavity. Metastases to the myocardium are less common, but arise more commonly when cancer spreads via the blood.
Primary cardiac tumors, on the other hand, are actually extremely rare. The most common type of primary tumors in adults — when they do happen — are myxomas. Myxomas are benign tumors that arise from the mesenchymal connective tissue inside the heart, as opposed to the actual myocytes, or heart cells, because the heart of an adult is fully developed and its cells, or myocytes, are permanent and don’t proliferate.
These masses are gelatinous in consistency, as a result of an abundance of ground substance on histology, and pedunculated, meaning attached to a peduncle, or a stalk of tissue.
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "Cardiac Tumors" Deutsches Ärzteblatt international (2014)
- "Cardiac Tumors: Clinical Perspective and Therapeutic Considerations" Current Drug Targets (2017)