An unusual location of a papillary fibroelastoma

A 72-year-old woman was hospitalized with recurrent acute coronary syndrome after initial successful treatment of acute ST-elevation myocardial infarction with percutaneous coronary intervention. Echocardiography demonstrated unexpectedly a 9 x 8 mm pendulating structure attached to the anterior, proximal interventricular septum in the left ventricular outflow tract 6 mm beneath the aortic valve annulus. Magnetic resonance imaging of the heart yielded the same findings. The patient underwent coronary artery bypass grafting and tumour excision. The histopathological findings were typical for papillary fibroelastoma (PFE) with a central zone of connective tissue and some elastic fibres without blood vessels and covered by endocardium. PFE is the third most common type of primary cardiac tumours, second to myxoma and lipoma. PFEs are avascular papillomas that predominantly occur on the aortic and mitral valves (90%). However, the present case demonstrates that PFE occasionally can be attached to the ventricular wall endocardium.