VASCULAR TUMORS

Endothelial neoplasms

Angiosarcoma - a malignant vessel. It usually appears on the skin, liver or breast. It looks like a weird, irregular bruise. It’s highly aggressive. Liver angiosarcoma is associated with environmental exposure to PVC or arsenic, so be suspicious if the patient works in a factory. It’s also seen in the setting of chronic lymphedema. (No picture yet)

MYXOMA

Heart tumor

A Cardiac Myxoma is a rare benign heart tumor. It usually appears in the left atrium, and it grows off of the atrial septum on a stalk (pedunculated like Gary’s eyeballs). The tumor ball tends to plop into the mitral valve, obstructing flow into the left ventricle (can mimic mitral stenosis). This suddenly drops the cardiac output and can cause syncope. On auscultation, the myxoma actually makes a plopping sound!

Cancers of the heart are quite rare, because the cardiac myocytes don’t replicate. Instead, the tumor arises from the connective tissue (mesenchyme) of the heart. The tumor itself is quite soft and squishy, and most of it is composed of connective tissue and mucopolysaccharides (myxoid). In some cases, the squishy tumor can disintegrate, spewing emboli everywhere! The diagnosis is confirmed using histology, where you can see a largely hypocellular environment with lots of translucent pink jelly (this is the mucopolysaccharides).