PMC3981096_01
Transesophageal echocardiography and cardiac magnetic resonance imaging: (A) transesophageal echocardiogram in the left ventricular outflow tract view showing a spherical, homogenous, echo-dense mass measuring approximately 0.9 cm x 0.9 cm arising from the left ventricular septum (arrow), (B) magnified view of the left ventricular septal mass, (C) cardiac magnetic resonance delayed enhancement images in the long axis and (D) short axis showing signal hyperintensity of left ventricular septal mass after gadolinium administration (arrow).
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F1
Based on its characteristic appearance and echogenicity, pedunculated nature, and mobility, the mass was identified as a papillary fibroelastoma (Fig. 1A and B; Supplementary data: Videos 1 and 2). Delayed enhancement images after administration of gadolinium demonstrated signal hyperintensity caused by the fibroelastic nature of the mass (Fig. 1C and D).
Surgical pathology and histopathology: (A) surgical specimen of gelatinous, friable, papillary mass resected from the left ventricular septum via ventriculotomy, (B) low power hematoxylin and eosin photomicrograph demonstrating branching papillae consisting of hypocellular collagenous cores lined by a layer of endocardial cells and loose myxoid matrix, (C) immunoperoxidase stain for CD34 highlights the endocardial lining and (D) trichrome stain highlights the collagenous nature of the cores.
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F2
The surgical specimen was a friable, gelatinous mass that was loosely attached to the left ventricular septal wall (Fig. 2A). Low magnification hematoxylin and eosin stain demonstrated branching papillae consisting of hypocellular collagenous cores lined by a layer of endocardial cells and loose myxoid matrix (Fig. 2B). Immunoperoxidase stain for CD34 highlighted the endocardial lining (Fig. 2C); trichrome stain demonstrated the collagenous nature of the cores (Fig. 2D).