Fibroelastoma Recurrence in Left Ventricle: Rarity of Primary Cardiac Tumor

Abstract

Cardiac papillary fibroelastoma is a primary cardiac neoplasm with an unknown prevalence but is increasingly detected by echocardiography.A 70-year-old asymptomatic man (98 kg; 178 cm) was referred in 2014 to our hospital for evaluation of two suspected cardiac tumors in the left ventricle after his first open heart surgery for fibroelastoma via conservative sternotomy in year 2005. The patient presented to our hospital with no neurologic, cardiac, or other signs or symptoms of general discomfort before he was scheduled for surgery.In 2005, after a singular transient ischemic event, a cardiac tumor was confirmed by transesophageal echocardiography in the left ventricle intertwined in the papillary muscle belly close to the mitral valve cusp. The tumor was surgically resected through a median sternotomy with the mitral valve preserved. At that time, no visible residues of the fibroelastoma had been left macroscopically, and no clinical complications in the surgical and postoperative course were then observed. During the surgery in 2005, the tumor was found on the A1 segment of the anterior leaflet and on the posterior chordae in two parts. The tumor was resected with visual confirmation. The histologic evaluation indicated a primary cardiac papillary growth with a pale basophilic myxoid stroma, with nuclear matrix eosinophilic without neoplasm potency (►Fig. 1A). Annual echocardiography and regular blood tests showed no fibroelastoma present or mitral valve dysfunction.Three years following removal of the fibroelastoma, a small formation of the tumor was detected by echocardiography. The clinical course was uneventful; therefore, no special treatment was indicated at that time. From 2013 to 2014, the tumor rapidly grew, and the patient developed benign prostate hyperplasia, which was treated with Doudart 0.4 mg (dutasteride þ tamsulosin; GlaxoSmithKline, London, United Kingdom).In 2014, the fibroelastoma recurred as detected by transesophageal echocardiography. The function of the mitral valve was normal, but the tumor tissue was detected between the papillary muscle and the chordae tendineae. Magnetic resonance imaging revealed two separate mobile and noncalcified spherical structures (1 Â 0.