心脏脂肪瘤的临床病理特点

目的：总结心脏脂肪瘤的病理形态特点，结合临床分析其意义。方法：收集并分析384例原发性心脏肿瘤中脂肪瘤病例的年龄、性别、就诊目的和心电图改变，核查肿瘤生长部位、大小和组织学特点。结果：检出脂肪瘤9例，占心脏和心胞肿瘤的2.34％。7例伴有异常Q波、频发室早和低电压等心电图改变。肿瘤分别位于心脏表面4例、心室腔面3例、房间隔1例和二尖瓣1例。病理表现为心外膜脂肪瘤样肥厚1例，孤立性脂肪瘤4例和浸润性脂肪瘤4例，未见房间隔脂肪瘤样肥厚和脂肪肉瘤。手术切除后6例痊愈，1例出现房扑，2例仍存异常Q波和短阵室速。结论“脂肪瘤是继黏液瘤后的第二位心脏原发性肿瘤，脂肪瘤的组织学诊断须结合临床及影像学结果分析，孤立性脂肪瘤预后较好，而浸润性脂肪瘤不易切净，心律失常不易根治。

Clinical and pathological characteristics of cardiac lipoma

Purpose To investigate the morphological characteristics and its clinical significance of cardiac lipoma. Methods Nine cases of lipoma out of 384 primary cardiac tumors were collected with their age, sex, history of disease and ECG records, followed by reviewing tumor's location, gross appearance and histopathological findings. Results The percentage of cardiac lipoma among the primary cardiac tumors was 2 34%. There were 7 cases with abnormal Q wave, ventricular ectopic and lower voltages of ECG. Cardiac lipoma were found in pericardial cavity (4 cases), ventricular cavity (3 cases) and on the surface of interatrial septum (1 case) and the atrial surface of mitral valve (1case). Nine cases of lipoma could be divided into two groups as solitary lipoma (5 cases with a special case of lipomatous hypertrophy of epicardium) and infiltrating lipoma (4 cases) according to its pathological characteristics. There was no any case with lipomatous hypertrophy of interatrial septum and liposarcoma. Six cases recovered completely while the other 3 cases still had some arrhythmia following surgical excision. Conclusions Lipoma is the second common cardiac benign tumor behind myxoma. It is necessary for a pathologist to refer the clinical and radiological findings when he considers a tumor as cardiac lipoma. Solitary lipoma has a better prognosis than infiltrating lipoma. The latter is not easy to be excised completely and the arrhythmia may remain in some cases after surgical operation.