Heart
Cardiac tumors - benign
Papillary fibroelastoma


Topic Completed: 1 November 2013

Revised: 1 March 2019

Copyright: 2007-2019, PathologyOutlines.com, Inc.

PubMed Search: Papillary fibroelastoma [title] heart pathology review[ptyp]

Nat Pernick, M.D.
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Cite this page: Pernick N Papillary fibroelastoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/hearttumorfibroelastoma.html. Accessed August 25th, 2019.
Definition / general
  • Also called giant Lambl excrescence
  • 8 - 10% of all heart tumors; third most common after myxoma and lipoma
  • Mean age 60 years
  • Benign
  • Usually an incidental finding at autopsy, although may embolize (higher risk if large, mobile, left sided, Circulation 2001;103:2687), or prolapse into coronary artery
  • More common on valve surface or endocardium
  • Associated with prior cardiac surgery or thoracic radiation (Hum Pathol 2002;33:1165)
Case reports
Treatment
  • Either no intervention, excision or warfarin
Gross description
  • Distinctive cluster of yellow-white hair-like projections up to 1 cm in diameter covering large portions of valvular surface (usually aortic and mitral)
Gross images
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Mitral valve

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Tumor in noncoronary sinus



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Multiple small fronds resembling a sea anemone

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Causing sudden
death due to
occlusion of right
coronary ostium
Microscopic (histologic) description
  • Narrow, elongated and branching papillary fronds composed of central avascular collagen and variable elastic tissue, surrounded by acid mucopolysaccharide and lined by hyperplastic endothelial cells
Microscopic (histologic) images
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Arising from aortic valve cusp

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Movat pentachrome stain

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Avascular fronds lined by endothelial cells

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Papillary configuration may
be obscured by scarring,
but trapped cores of elastic
tissue are usually present


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Colloidal iron stain

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Avascular fronds lined by endothelial cells

Differential diagnosis
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