Comparison of echocardiography and surgical pathology in pediatric cardiac tumor with follow-up: a single-center retrospective study.

backgroundAlthough cardiac tumor in children are clinically rare, they present significant diagnostic challenges. This study aims to characterize the echocardiographic features of pediatric cardiac tumor and to correlate these findings with surgical and pathological results, thereby improving diagnostic accuracy. A further objective is to conduct long-term follow-up of surgical patients to provide insights into the prognosis and management of primary cardiac tumors in this population.

methodsA retrospective analysis was conducted on pediatric patients under 18 years of age with cardiac tumor confirmed by both echocardiography and surgical pathology at our institution from January 2004 to January 2025. The inclusion criterion was confirmation of the lesion by both preoperative echocardiography and postoperative pathological analysis following surgical resection. Demographic and clinical data, including gender, age, clinical manifestations, and arrhythmias, were qualitatively summarized. Echocardiographic, surgical, and pathological findings were statistically analyzed. Long-term follow-up was performed to assess tumor recurrence, postoperative complications, and overall prognosis.

resultsOf the 18 pediatric patients included, 11 (61.1%) were symptomatic at presentation, with arrhythmias being the most common manifestation, observed in 9 (81.8%) of these symptomatic patients. Lesion size ranged from 0.4 to 10 cm, and the majority were solitary. Pathological analysis identified rhabdomyoma (n = 8, 44.4%), fibroma (n = 6, 33.3%), myxoma (n = 2, 11.1%), and cystic lesions (n = 2, 11.1%). The anatomical distribution varied by tumor type. Rhabdomyomas were most frequently found in the left ventricle (n = 2), with other locations including the right ventricle, right atrium, both ventricles, aortic valve, and superior vena cava (n = 1 each). All fibromas were predominantly located in the left ventricle (n = 5), with one case in the right atrium. The two myxomas were located in the right atrium and were multifocal with scattered distribution, respectively. The cystic lesions were located subaortic and on the posterior left ventricular wall (n = 1 each). A high concordance was observed between echocardiographic and pathological diagnoses, although discrepancies were noted in a subset of cases.

conclusionThis study confirms that primary cardiac tumor in children are predominantly benign, with rhabdomyoma and fibroma being the most common histological types. Clinical presentation is highly variable, with arrhythmias representing a frequent and significant symptom. While echocardiography serves as a reliable primary diagnostic tool, our findings highlight the potential for diagnostic discrepancies with histopathology, underscoring the need for careful interpretation. Ultimately, our data support a tailored approach to clinical management, where decisions on intervention are critically dependent on a comprehensive assessment of the tumor’s specific type, location, and size. This work provides valuable real-world data to enhance diagnostic accuracy and inform optimal management strategies for these rare conditions.