GPR: 2019 - Week 38

From MGH Learn Pathology

Clinical history

65 year old male, autopsy, metastatic cholangiocarcinoma

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Nonbacterial thrombotic endocarditis
  • Characteristic red, granular gross appearance
  • 0.3-9.3% of autopsy patients; usually mitral & aortic valves
  • Associated with widespread malignancies (esp. lung, ovary, biliary system, pancreas, stomach) and autoimmune diseases (SLE, antiphospholipid syndrome)
  • Composed of fibrin and platelet aggregates; devoid of inflammation or bacteria
  • Underlying valve usually normal

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Infective endocarditis

  • Firm, tan grey vegetations with destruction of underlying valve
  • Less friable and less likely to embolize than NBTE
  • Histologically composed of thrombus mixed with acute inflammatory cells and bacterial colonies

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Papillary Fibroelastoma

  • “Sea anemone“ appearance
  • Avascular papillary fronds composed of elastic fibers lined by surface endothelium arising from a common stalk
  • Most common primary tumor of cardiac valves; unknown etiology

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Cardiac myxoma

  • Most common in left atrium, but can be found anywhere in the heart, rarely valves
  • Soft gelatinous/mucoid with smooth or papillary surface; often with significant intratumoral hemorrhage
  • Myxoma cells seen individually and growing around thin walled vessels in a myxoid background

This week's Gross Pathology Roundup was presented by [[| , ]] on Mon, Sep 16, 2019.