Discussion:
Primary cardiac tumours in childhood have a very low incidence, although
in recent years, the incidence has increased because of improvements in
heart imaging techniques[3] [4]. Most primary
cardiac tumours are benign in the sense they are not invasive. However,
benign tumours maintain the potential for serious illness related to
significant haemodynamic compromise or life-threatening dysrhythmias. In
most cases, the first clinical manifestation depends on the tumour
location and size. In our case, the mass was not very large in size, and
the patient was symptomatic with the persistence of a heart murmur.
Due to the association of lipoblastoma with other heart malformations,
preoperative diagnosis remains challenging. Transthoracic
echocardiography has high sensitivity for the detection of cardiac
masses. It can often provide precise information about the tumour size,
location, shape, mobility, and associated features. It is usually the
first-line investigation. Cardiac MRI is especially advantageous in
defining tissue characteristics and, through the use of gadolinium-based
contrast agents, in differentiating between cardiac masses such as
tumours, which display variable enhancement, and thrombi, which do not
enhance at all[5]. Before the operation, this
patient was considered to be diagnosed with congenital valvular stenosis
and ASD, therefore, no MRI was applied. The diagnosis of lipoblastoma is
often made postoperatively. It demonstrated adipocytes in different
stages of maturation without anaplasia. The main histological features
of the tumour were multinodular and myxoid foci. Chromosomal
abnormalities have been reported in lipomatous tumours. In our case, we
did not perform any genetic study because the histopathological
evaluation alone was definitive.
Tumours on the heart valve are more likely to cause haemodynamic
disturbances. Complete resection yields an excellent
prognosis[4,6]. Occasionally, the resection of
adjacent structures is necessary to achieve complete extirpation;
however, in our patient, the resection of the adherent pulmonary valve
was not required. The resection of the tumour and its adjacent tissue
may damage the heart structure; therefore, it is important to carefully
evaluate preoperative parameters.
Conflicts of interest: On behalf of all authors, the corresponding
author states that there is no conflict of interest.
Funding: The study did not receive funding.
Ethical Standards:The study was approved by Beijing children’s Hospital
Clinical New Technology and Research Ethics Committee.