Overview
Cystic tumor of the atrioventricular node (CTAVN) is a rare benign neoplasm typically found incidentally or associated with conduction abnormalities like atrioventricular block 1.Diagnosis
Microscopic examination reveals a bilayered structure with tumor glands and corpora amylacea 1.
Immunohistochemistry shows inner cells positive for markers like CAM5.2, CEA, EMA, olfactomedin-4, and alpha-methylacyl-coenzyme A racemase; outer cells positive for p63 and high molecular weight cytokeratin 1.
Prostatic markers and hormone receptors may show variable expression, particularly in males 1.Management
No specific drug treatments are mentioned; management often involves addressing underlying conduction abnormalities 1.
Pacemaker implantation may be necessary for patients with significant atrioventricular block 1.
Surgical intervention is considered for symptomatic cases or those causing hemodynamic compromise, though complete resection may not always be feasible 2.Special Populations
Elderly: May present with pre-existing conduction issues like complete atrioventricular block requiring pacemaker support 1.
Comorbidities: Patients with sinus bradycardia or first-degree AV block may require careful monitoring and supportive interventions 1.Key Recommendations
Perform histopathological examination including immunohistochemistry to confirm diagnosis and assess cellular markers 1 (Evidence: Moderate).
Consider pacemaker implantation for patients with significant atrioventricular block secondary to CTAVN 1 (Evidence: Moderate).
Partial surgical resection may be adequate for symptomatic cases, allowing for long-term survival without complete tumor removal 2 (Evidence: Weak).References
1 Ichimata S, Hata Y, Yajima N, Katayama Y, Nomoto K, Nishida N. Sex-dependent expression of prostatic markers and hormone receptors in cystic tumor of the atrioventricular node: A histopathological study of three cases. Pathology international 2021. link
2 Ceithaml EL, Midgley FM, Perry LW, Dullum MK. Intramural ventricular fibroma in infancy: survival after partial excision in 2 patients. The Annals of thoracic surgery 1990. link90501-v)