Papillary fibroelastoma: A unique case of distant recurrence

An unusual case of recurrence of papillary fibroelastoma: a case report

Background

Papillary fibroelastomas (PFEs) are uncommon primary cardiac tumours and their recurrence after resection is rare.

Case summary

A 32-year-old woman, who was evaluated for recurrent embolic stroke, was found to have lesions on mitral leaflets on echocardiography. The mitral leaflets were otherwise normal with no clinical or laboratory evidence of infective endocarditis. Transthoracic, as well as transesophageal echocardiography, revealed masses on mitral leaflets, which remained almost the same over 3 years. A tentative diagnosis of PFE on the mitral valve was made. She had undergone intra-cardiac excision of mitral valve mass along with ring annuloplasty in February 2020. In November 2021, during her regular follow-up visit, transthoracic echocardiography revealed the recurrence of the masses on mitral leaflets with severe mitral regurgitation. She underwent mitral valve replacement and excision of tumour masses. Histopathological examination confirmed the diagnosis of recurrent PFE.

Discussion

Recurrence of PFEs is rare. We report a rare case of histologically proven recurrence of PFE of the mitral valve. This highlights the importance of routine post-operative echocardiographic follow-up in patients with PFE.

Left Ventricular Papillary Fibroelastoma Presenting with Dyspnea on Exertion

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A patient presented with reduced effort tolerance and abnormal stress test.

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He was subsequently found to have a left ventricular mass.

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Multimodal imaging was utilized; however, diagnostic certainty remained limited.

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Cardiac surgery was pursued, wherein a single left ventricular mass was resected.

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Biopsy was consistent with cardiac papillary fibroelastoma.

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On follow-up, the patient reported a return to prior functioning.