Clinicopathological analysis of 124 cardiac tumors: a single-center retrospective study

Objective To characterize the clinicopathological features, pathological spectrum, and anatomical distribution of cardiac tumors and to evaluate the diagnostic challenges associated with these rare lesions. Methods A retrospective analysis was performed on 124 surgically resected cardiac tumors diagnosed at the Affiliated Hospital of Zunyi Medical University between January 2012 and June 2026. Histological examination, immunohistochemistry, and fluorescence in situ hybridization (FISH), when indicated, were reviewed. All tumors were reclassified according to the 2021 WHO Classification of Thoracic Tumours. Clinicopathological characteristics and exploratory statistical analyses were performed. Results Among the 124 cardiac tumors, myxoma constituted the predominant entity (104/124, 83.9%). A marked predilection for the left atrium was noted, with 78.8% of myxomas located there (82/104), significantly surpassing the frequency in the right atrium ( P < 0.001). Although malignant tumors were uncommon (12 cases), they exhibited considerable histopathological diversity. Exploratory analysis revealed a higher proportion of malignant tumors in patients aged ≤ 50 years compared to older patients (19.1% vs. 3.9%, P = 0.013). Conclusions This single-center retrospective series highlights the diverse histopathological spectrum of cardiac tumors, affirming myxoma as the predominant tumor type with a strong left atrial predilection. Although rare, malignant tumors presented diagnostic challenges, necessitating multidisciplinary evaluation that integrates morphology, immunohistochemistry, and molecular testing. The observed age-related difference in the distribution of malignancy should be regarded as exploratory and requires further validation.