PMC4573212_01
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.
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She received antibiotics for 2 weeks to treat a suspicious vegetation apparent on TTE (Fig. 1A). TEE revealed a mass of >1.0 cm2 in size, mobile, attached to anterior mitral leaflet on the atrial aspect, and round with a homogenously speckled surface (Fig. 1B). There was moderate to severe mitral regurgitation. Under standard cardiopulmonary bypass, the left atrium was opened and the mass was identified (Fig. 1C). Macroscopically the excised lesion was composed of a soft beige tissue with micropapillary projections and lobulated surface of 1.2 x 0.8 cm, entirely processed (Fig. 1D).
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)
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The histology examination revealed a papillary lesion composed of numorous papillary fronds with an acelular fibro-hialinous stroma (Fig. 2A and B). Those projectiones are covered by endothelial cells (Fig. 2C). A higher magnification demonstrates a myxoid papillary structure lined by endothelial cells which express endothelial cell markers (Fig. 2D).