Papillary fibroelastoma of the anterior leaflet of the mitral valve mimicking vegetation

Abstract

Introduction: The papillary fibroelastoma (PFE) is a rare and benign primary cardiac tumor, and the mostly frequently found tumor occurring in cardiac valves.

Case presentation: We describe a 52 year old female presenting a history of 2 weeks of fever due to wound infection after breast's surgery. A preoperative echocardiography demonstrated a mass >1cm(2) originating from the anterior leaflet of the mitral valve mimicking vegetation. The patient underwent successful surgical removal of the PFE. The histologic evaluation demonstrated a PFE.

Discussion: With the introduction of echocardiography, the diagnosis of these tumors in living patients has been reported sporadically. PFE have been found most often on valve leaflets, chordae tendineae, and both ventricles. The differential diagnosis of PFE includes other cardiac tumors, thrombus, vegetation, and Lambl's excrescences.

Conclusion: To summarize, we report a PFE of the anterior leaflet of the mitral valve. The diagnosis was confirmed by histopathological examination after surgical removal. Finally, careful echocardiographic analyses during evaluation of valvular masses are strongly recommended for differential diagnosis.

Keywords: Mitral valve; Papillary fibroelastoma; Transesophageal echocardiography.

Fig. 1

Transthoracic echocardiography shows a mobile and spherical mass of 1.0 cm in size attached to anterior mitral leaflet. Parasternal long axis view (A) and an apical four-chamberview (B). Gross specimen of excised mass reveals a friable mass with frond-like surface.

Fig. 2

Papillary fibroelastoma. Low magnification demonstrates a papillary configuration of paucicellular fronds (A, B H–E 10X). A higher magnification demonstrates a myxoid papillary structure lined by endothelial cells which express endothelial cell markers (C H–E 40X, D,CD 34 20X)