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Images in Cardiothoracic Medicine and Surgery
Cardiac papillary fibroelastoma: the image behind diagnosis
Asian Cardiovascular & Thoracic Annals 0(0) 1–2 ß The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492314550726 aan.sagepub.com
Anjith Prakash1, Jacob Jamesraj1 and Kumar Chidambaram2
Figure 1. Two-dimensional transesophageal echocardiography showing a 1.65 1.85-cm pedunculated freely mobile cardiac papillary fibroelastoma in the left atrium with a stippled appearance, shimmer of the peripheral edge, and echolucency within.
Figure 3. Gross histopathological specimen of the cardiac papillary fibroelastoma.
Figure 4. Histology of the cardiac papillary fibroelastoma. Hematoxylin and eosin stain, original magnification 100. Figure 2. Three-dimensional transesophageal echocardiography showing the cardiac papillary fibroelastoma arising from the left atrium very near the P1 segment of the mitral valve.
A 52-year-old asymptomatic man, on follow-up after a primary percutaneous coronary intervention to the left anterior descending artery, was diagnosed with a freely floating soft tissue mass measuring 23 25 mm with equal echogenicity with a stalk attached to the posterior mitral leaflet, on transthoracic echocardiography. Preoperative 2-dimensional (Figure 1) and 3-dimensional (Figure 2) transesophageal echocardiography showed the characteristic stippled appearance with shimmer of the peripheral edge and echolucency
within the tumor, suggestive of cardiac papillary fibroelastoma. Intraoperatively, a 20 25 25-mm soft pedunculated polypoid mass was found attached to the left atrial wall 3 mm from the mitral valve P1 region. 1 Department of Cardiothoracic and Vascular Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, India 2 Department of Cardiac Anesthesiology, Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, India
Corresponding author: Anjith Prakash, MBBS, Department of Cardiothoracic and Vascular Surgery, Institute of Cardiovascular Diseases, Madras Medical Mission, 4A, Dr. JJ Nagar, Mogappair, Chennai-600037, Tamil Nadu, India. Email: [email protected]
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2
Asian Cardiovascular & Thoracic Annals 0(0)
Postoperative transesophageal echocardiography following excision showed no mitral regurgitation. Histopathology showed a papillary tumor composed of filiform processes with a central acellular collagen core surrounded by myxomatous matrix. The peripheral rim and core showed coarse elastin fibrils lined by endothelial cells, confirming the diagnosis of cardiac papillary fibroelastoma (Figures 3 and 4).
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest statement None declared.
Downloaded from aan.sagepub.com at Univ of Illinois at Chicago Library on May 5, 2015
(AAN)
[1–2] [PREPRINTER stage]
Images in Cardiothoracic Medicine and Surgery
Cardiac papillary fibroelastoma: the image behind diagnosis
Asian Cardiovascular & Thoracic Annals 0(0) 1–2 ß The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492314550726 aan.sagepub.com
Anjith Prakash1, Jacob Jamesraj1 and Kumar Chidambaram2
Figure 1. Two-dimensional transesophageal echocardiography showing a 1.65 1.85-cm pedunculated freely mobile cardiac papillary fibroelastoma in the left atrium with a stippled appearance, shimmer of the peripheral edge, and echolucency within.
Figure 3. Gross histopathological specimen of the cardiac papillary fibroelastoma.
Figure 4. Histology of the cardiac papillary fibroelastoma. Hematoxylin and eosin stain, original magnification 100. Figure 2. Three-dimensional transesophageal echocardiography showing the cardiac papillary fibroelastoma arising from the left atrium very near the P1 segment of the mitral valve.
A 52-year-old asymptomatic man, on follow-up after a primary percutaneous coronary intervention to the left anterior descending artery, was diagnosed with a freely floating soft tissue mass measuring 23 25 mm with equal echogenicity with a stalk attached to the posterior mitral leaflet, on transthoracic echocardiography. Preoperative 2-dimensional (Figure 1) and 3-dimensional (Figure 2) transesophageal echocardiography showed the characteristic stippled appearance with shimmer of the peripheral edge and echolucency
within the tumor, suggestive of cardiac papillary fibroelastoma. Intraoperatively, a 20 25 25-mm soft pedunculated polypoid mass was found attached to the left atrial wall 3 mm from the mitral valve P1 region. 1 Department of Cardiothoracic and Vascular Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, India 2 Department of Cardiac Anesthesiology, Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, India
Corresponding author: Anjith Prakash, MBBS, Department of Cardiothoracic and Vascular Surgery, Institute of Cardiovascular Diseases, Madras Medical Mission, 4A, Dr. JJ Nagar, Mogappair, Chennai-600037, Tamil Nadu, India. Email: [email protected]
Downloaded from aan.sagepub.com at Univ of Illinois at Chicago Library on May 5, 2015
XML Template (2014) [25.8.2014–4:38pm] //blrnas3/cenpro/ApplicationFiles/Journals/SAGE/3B2/AANJ/Vol00000/140203/APPFile/SG-AANJ140203.3d
(AAN)
[1–2] [PREPRINTER stage]
2
Asian Cardiovascular & Thoracic Annals 0(0)
Postoperative transesophageal echocardiography following excision showed no mitral regurgitation. Histopathology showed a papillary tumor composed of filiform processes with a central acellular collagen core surrounded by myxomatous matrix. The peripheral rim and core showed coarse elastin fibrils lined by endothelial cells, confirming the diagnosis of cardiac papillary fibroelastoma (Figures 3 and 4).
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest statement None declared.
Downloaded from aan.sagepub.com at Univ of Illinois at Chicago Library on May 5, 2015
