Papillary fibroelastoma of the heart

Last revised by Yuranga Weerakkody on 21 May 2024

Papillary fibroelastomas are rare benign primary cardiac tumors. However, of the primary cardiac tumors, they are one of the commonest to occur in relation to the cardiac valves (may account for 75% of valvular tumors 10). 

Its estimated prevalence ranges between <0.01 to 0.33% 5. There may be slightly increased male predilection 10.

Characterized by a papillary growth of stromal tissue composed of a central dense amorphous fibrous core and a surrounding layer of loose connective tissue. There is also a layer of elastic fibers (hallmark) which is variable in distribution. This is further surrounded by a single layer of hypertrophied endothelium. 

Approximately 80% occur in relation to either the aortic or mitral valve 2 while tricuspid and pulmonary involvement are much rarer. Very rarely they can also involve the mitral chorda 13.

Typically seen as a small (~1.5 cm 5) well-defined pedunculated mass in relation to a valve.

  • T1: intermediate intensity 1,2

  • T2: intermediate to high intensity 1,2

  • SSFP Cine: may be useful for showing mobility (often highly mobile)

Small hypodense mass with irregular borders.

Small pedunculated mass with multiple papillary projections that provides it with the classical appearance of a sea anemone 14.

Surgical resection of the tumor is the treatment of choice and the valve may require replacement.

  • systemic embolization of tumor or thrombotic components 5

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