GPR: 2019 - Week 49

From MGH Learn Pathology

Clinical history

71 year old female with a history of cerebral infarction and remote breast cancer. A cardiac mass was identified at autopsy.

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Papillary fibroelastoma
- Most common primary neoplasm of cardiac valves

- Papillary structure with mobile fronds

- May have calcification or adherent thrombus

- May occur after cardiac procedures or instrumentation

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Cardiac myxoma

- Most common primary cardiac neoplasm

- 3rd to 6th decade - Most commonly atrial, left sided, often near the fossa ovalis

- Rarely on valve leaflets or cusps

- Heterogeneous, with soft, gelatinous or friable texture, and may contain calcification or hemorrhage

- Pedunculated or sessile, smooth or papillary

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Nonbacterial thrombotic endocarditis

- Vegetations composed of fibrin and platelets

- Associated with neoplasms, autoimmune conditions, and valvular diseases

- Commonly incidental, usually in 4-8th decades

- Most commonly on mitral and aortic valves

- Verrucous, either firmly attached or friable

- Most are <1 cm, broad based and irregular

Dr. Abner Louissaint

Dr. Diane Brackett

Emma Thompson
Maleszewski JJ. Cardiac Myxoma. ExpertPath. myxoma. Accessed October 15, 2019.

Maleszewski JJ. Papillary Fibroelastoma. ExpertPath. fibroelastoma. Accessed October 15, 2019.

Nair V., Revelo MP., Nonbacterial Thrombotic Endocarditis. ExpertPath. Accessed November 30, 2019.

This week's Gross Pathology Roundup was presented by Caroline Hilburn, MD on Mon, Dec 02, 2019.