A Common Disease, an Uncommon Location: Left Ventricle Papillary Fibroelastoma

Abstract

Cardiac papillary fibroelastoma (PFE) is a rare benign cardiac tumor, usually associated with cardiac valves. Cases of non-valvular, left ventricular (LV) cavity PFE are extremely rare. We report the case of a 75-year-old man with a history of exertional chest pain. He was referred to our tertiary-care hospital for evaluation. On the echocardiogram, the patient was found to have a LV lesion related to the papillary muscle. Cardiac magnetic resonance imaging revealed an enhancing mobile lesion related to the LV anterolateral papillary muscle which suggested a myxoma. The patient underwent surgical resection of the lesion, later histopathologically confirmed to be PFE.

Keywords: Cardiac Papillary Fibroelastoma; Cardiac Tumor; Oman.

Figure 1

Cardiac magnetic resonance images showing (a) a steady-state free precision short-axis oblique and (b) T2-weighted images showing a small lesion related to the left ventricle anterolateral papillary muscle 9. An enhancing lesion related to the left ventricle anterolateral papillary muscle 9 is shown by the (c) late gadolinium enhancement short-axis oblique and (d) four-chamber view.

Figure 2

Microscopic section of the excised lesion in two magnifications. (a) The lesion is seen composed of many papillary fronds, (hematoxylin and eosin staining, magnification = 40 ×). (b) The papillary fronds reveal avascular hyalinized cores lined by a single layer of endocardial cells, magnification = 100 ×.