ASYMMETRICAL HYPERTROPHY OF THE HEART IN YOUNG ADULTS

Abstract

Tumours of the heart and pericardium have evoked an extensive literature out of all pro- portion to their uncommon incidence and their relative unimportance as a cause of clinical heart disease."This opening sentence of Friedberg's chapter on cardiac tumours in Diseases of the Heart (Friedberg, 1949) fills a pathologist with diffidence in reporting eight cases that have been seen in the last six years in a series of 16,000 autopsies.Primary tumours of the heart are undoubtedly a rarity and according to Mahaim (1945) 413 had been recorded up to 1945.There is little justification for recording rarities in young adults unless they have some relation to fitness for military service or confuse the differential diagnosis, particularly of conditions that may respond to cardiac surgery.These eight cases of asymmetrical hypertrophy or benign tumour of the heart have occurred in a large group where sudden death and indeed cardiac incapacity, particularly among men, is rare.Primary tumours of the heart fall into three categories.(1) Multiple tumours frequently described as congenital glycogenic tumours of the myocardium, which are often associated with other presumably congenital lesions such as tuberous sclerosis and renal tumours.(2) Single diffuse tumours or asymmetrical hypertrophy of muscle and connective tissue, which are the subject of this article.(3) Rare myxomata and sarcomata, occurring mainly in later life and producing a variety of symptoms and pathology.Since the term rhabdomyoma is now firmly associated with nodular glycogenic tumours of the heart it is simpler to refer to the eight tumours under discussion as hamartomata, though they may in fact lay greater claim to being benign tumours of striped muscle than those of presumed glyco- genic origin.In Mahaim's (1945) extensive review, which included 329 cases of primary tumour of the heart, only six are referred to as being diffuse tumours of the myocardium, and it would appear that the tumours discussed in this paper fall into this category.Batchelor and Maun (1925) in recording one case of multiple tumours of the heart in a child of three days reviewed 62 other reported cases.In 60 cases the lesions were multiple, and of the three other cases, one was recorded as having hepatomegaly, one had congenital tumour of the lung, and one had no congenital abnormality.In Eulinger's (1925) record of 37 cases, seven were single tumours and no other congenital abnormality was found.Browne and Gray (1930) record a case of a child of three months who died following a fit of crying, and there was found a diffuse tumour of the lateral wall of the left ventricle similar to the cases about to be described.Hueper (1935 and 1941) described diffuse tumours in the heart of a negro and in the heart of a guinea-pig.Saphir (1953) used the term rhabdomyoma when writing of nodular glycogenic degeneration and gives no reference to benign tumours of striped muscle.Similarly Adams, Denny-Brown, and Pearson (1953) describe nodular glycogenic tumours when referring to rhabdo- myoma of the heart.