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Autopsy of a 70-year-old woman reveals a papillary growth within the left ventricular chamber. The
growth consists of a small mass of finger-like projections attached to the mitral valve,
without associated valvular or other cardiac abnormalities. Histologically, each papillary
structure is composed of a core of fibrous tissue lined by thickened endothelium. The patient
did not have any history of cardiac disease or evidence of thromboembolism. Which of the
following is the most likely diagnosis?
A. Acute mural thrombus
B. Cardiac myxoma
C. Infective endocarditis
D. Nonbacterial thrombotic endocarditis
E. Papillary fibroelastoma
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WIKI:
They are the third most common type of primary tumor of the heart,[2] behind cardiac myxomas and cardiac lipomas.
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Good evening. Since there is no Mucus, i think its EEE !!!!
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Autopsy of a 70-year-old woman reveals a papillary growth within the left ventricular chamber. The
growth consists of a small mass of finger-like projections attached to the mitral valve,
without associated valvular or other cardiac abnormalities. Histologically, each papillary
structure is composed of a core of fibrous tissue lined by thickened endothelium. The patient
did not have any history of cardiac disease or evidence of thromboembolism. Which of the
following is the most likely diagnosis?
A. Acute mural thrombus
B. Cardiac myxoma
C. Infective endocarditis
D. Nonbacterial thrombotic endocarditis
E. Papillary fibroelastoma
Explanation:
The correct answer is E. Gross and microscopic features of this small mass in the left
ventricle are entirely consistent with papillary fibroelastoma. This lesion is not neoplastic,
despite the sound of the name. It probably results from organized thrombi forming on the
endocardial surfaces of the mitral valve or left ventricular cavity. Papillary fibroelastomas
are usually clinically silent and are discovered at autopsy as an incidental finding.
An acute mural thrombus (choice A) would not have a core of fibrous tissue. Acute mural
thrombosis usually develops as a result of stasis in the ventricular cavities, in association
with ventricular enlargement, myocardial infarction, or ventricular aneurysm, for example.
Thrombosis often develops in the atria when there is atrial fibrillation.
Cardiac myxoma (choice B) is the most frequent primary cardiac neoplasm. It is benign and
consists of stellate mesenchymal cells within a myxoid background. Since the left atrium is the
most frequent location, this tumor can produce mitral stenosis by a ball-valve effect.
Both forms of endocarditis are associated with formation of vegetations attached to the surface
of the atrioventricular valves. Vegetations of infective endocarditis (choice C) are bulky and
composed of fibrin, bacteria, and inflammatory cells. Since nonbacterial thrombotic
endocarditis (choice D) is caused by hypercoagulable states, the vegetations consist of
aggregates of fibrin but few inflammatory cells and no bacteria.
Note that all of the above conditions may lead to systemic embolization. Fragments of
vegetations, thrombi, myxoma, and papillary fibroelastoma may detach and be released into the
bloodstream, causing infarcts.
