Tricuspid papillary fibroelastoma at multimodal imaging

Abstract

Papillary fibroelastoma is a rare benign cardiac tumor, second after cardiac myxoma as more frequent cardiac valvular tumor. The therapy is usually based on surgery according to size, mobility, symptoms, and risks of surgery. We report the case of a 67-year old female with transient ischemic attack. Echocardiography showed the presence of a round mobile formation localized on the atrial side of septal leaflets of tricuspid valve, first identified as an endocarditis vegetation. Cardiac magnetic resonance (cMRI) confirmed the presence of the mass and showed an isointense signal in T1-turbo spin echo sequences, hypointense in cine steady-state free precession and in first-pass sequences, and hyperintense in T2 and phase-sensitive inversion recovery with central hypointense core, with a suspected diagnosis of fibroelastoma. The patient underwent cardiac surgery and histology confirmed the presence of fibroelastic tissue with papillary extroflexions compatible with diagnosis of fibroelastoma. The use of cMRI may be useful in the evaluation of the exact position, dimensions, and nature of cardiac masses and fibroelastomas, diagnostic workup, and preliminary assessment before surgery.

Discovery of Tricuspid Fibroelastoma on Echocardiography

“…Neoplastic cells have been found to be larger than normal cells thus containing more intracellular water, which leads to prolonged T1/T2 relaxation times thus allowing cMRI to pick up the inherent differences between tumors and normal tissue [6]. The gold standard for diagnosis of the tumor requires cMRI to differentiate it from other echogenic masses by way of the larger field of view, better special resolution and tissue characterization, lack of attenuation, and ability to image at any prescribed plane, allowing us to differentiate between tumor and thrombus [4,7].…”

Revisão bibliométrica e apresentação de caso clínico de um fibroelastoma papilifero

“…Além disso, seu núcleo tem a matriz constituída por colágeno, mucopolissacarídeos, fibras elásticas e raras células fusiformes com similaridade às células musculares lisas e fibroblásticas, assim tendo uma semelhança, de forma grosseira, à uma "anêmona do mar". A mobilidade desse tumor através dos pedúnculos, juntamente com os trombos aderentes e material de fibrina, representam uma fonte de êmbolo (Baikoussis et al, 2016;Casavecchia et al, 2018;Chung et al, 2020;Kumar et al, 2013;Rodrigues et al, 2018;Sousa-Uva & Cardim, 2018;Taha & Kumaresan, 2019).…”

An unusual case of localization of papillary fibroelastoma on the upstream side of the tricuspid valve

“…Primary cardiac tumors are rare, with an incidence rate of 0.0017%-0.019% in the autopsy series [2]. Papillary fibroelastomas account for less than 10% of primary cardiac tumors [3,4]. They are mostly asymptomatic and incidentally diagnosed by high-resolution imaging methods.…”