Papillary "tumours" of the left ventricle.

Abstract

We report here a unique case of intraventricular polyps of the left ventricle, which appear on gross and histological examination to be identical with papillary tumours of the heart valves. The case is of unusual interest in that the results of histochemical studies are consistent with the view of Koechlin (1908), subsequently elaborated by Pomerance (1961), that such "papillary tumours" are not neoplasms or hamartomas but may be giant Lambl's excrescences.Case Report A woman of 22 years developed severe palpitations during her first pregnancy and was found to have mitral stenosis. She gave birth to a premature child which survived. Three years later she became progressively dyspnoeic and had two hamoptyses. She was admitted to hospital at the age of 26 years for investigation. On examination she had cardiomegaly with a diastolic murmur at the apex conducted into the axilla. Fluoroscopy revealed enlargement of the right ventricular outflow tract and of the left atrium which expanded during ventricular systole indicating mitral incompetence. Cardiac catheterization showed a pulmonary arterial pressure of 63/39 mm. Hg and a wedge pressure of 30 mm. Hg at rest. The cardiac output was 5-8 1./min. The electrocardiogram showed right bundle-branch block. Two years later she had further h;moptyses and mitral valvotomy was performed successfully. Aschoff nodes were found in the amputated left atrial appendage. At the age of 31 years she required further bed-rest for dyspncea and hamoptysis in the third month of her second pregnancy. A second cardiac catheterization revealed a pulmonary arterial pressure of 70/36 mm. Hg, rising to 132/52 mm. Hg on exercise.Her cardiac output was 6-1 1./min. at rest. At the 31st week of pregnancy she was readmitted with pulmonary infarction. In July 1966 at the age of 39 years she was readmitted to hospital in congestive cardiac failure with dyspncea on exertion and recurrent hemoptyses. Emergency mitral valvotomy was performed but she developed cardiac arrest and died.Necropsy Findings. The enlarged heart weighed 690 g. and showed features consistent with pulmonary arterial hypertension. These were dilatation of the right atrium and ventricle, right ventricular hypertrophy (6 mm.), and dilatation and atheroma of the major pulmonary arteries. The basis for the pulmonary hypertension was mitral stenosis due to chronic rheumatic heart disease. The mitral valve cusps were thickened and fibrotic with nodular calcification; there was fibrosis of the short thick chordx tendineae and of the papillary muscles. The left atrium was greatly dilated and there was a calcified plaque, 2 cm. in diameter, situated 2 cm. above the mitral valve ring. The left ventricle contained multiple papilliferous polyps (Fig.

Pulmonary Eosinophilic Inflammatory Infiltration Post-Intensive Care in a Nearly Drowned Young Man with Papillary Fibroelastoma: A Rare Complication Discovered by Forensic Autopsy

“…Papillary fibroelastoma, also called fibropapilloma, or fibroelastic hamartoma, or Lambl’s excrescence, is a rare benign lesion of heart ( 1 ). It is the second most common primary cardiac neoplasm, accounting for 4.4–8% of all tumors of the heart ( 2 ).…”

Unusual and intraoperative epicardial echocardiographic features of a papillary tumour of the aortic valve.

“…Such cases seem to support the observation that the histological features of papillary tumours are not those of true neoplasms but resemble so-called giant Lambl's excrescences-lesions tht are thought to arise by the organisation of small deposits of fibrin at the sites of minor endothelial damage.6 It is hard to understand, however, how such a process could give rise to a mass almost 1 cm in diameter, as in our patient, without that mass becoming detached. Some have suggested that both papillary tumours and cardiac myxomas originate from organising mural thrombus,6 15 because papillary tumours have abundant extracellular acid mucopolysaccharides and a gelatinous consistency similar to that of cardiac myxomas, but this view is at odds with more recent reports of chromosomal abnormalities,'6 abnormal cell differentiation,'7 and neuroendocrine components"8 in myxomas.…”

Neoplasms Involving the Heart, Their Simulators, and Adverse Consequences of Their Therapy

“…They consist of fibrous tissue covered by an elastic membrane, which in turn is covered by endocardium. In about 15% of patients, they also occur on left ventricular or ventricular septal mural endocardium (102)(103)(104)(105)(106)(107)(108)(109)(110)(111), particularly in patients with small or relatively small ventricular cavities, such as in patients with hypertrophic cardiomyopathy (102,108) or mitral stenosis with or without aortic valve stenosis (106,109,110). When located on the aortic valve, papillary fibroelastomas are usually found on the ventricular aspects of the cusps in the more central portions.…”