Pathologically Proven Papillary Fibroelastomas Attached to the Left Atrial Appendage and Pulmonary Vein Ridge.

Area of Science:

• Cardiovascular Pathology
• Cardiac Oncology

Background:

• Papillary fibroelastomas (PFEs) are the most common primary cardiac tumors, predominantly affecting valvular structures.
• Despite their benign histology, PFEs carry a significant risk of systemic embolization, leading to potentially severe clinical outcomes.
• Extravalvular locations, such as the left atrial appendage (LAA) and pulmonary vein ridge, are less common but clinically relevant sites for PFEs.

Observation:

• This case series reviewed 13 pathology-proven PFEs located in the LAA and pulmonary vein ridge.
• The median patient age was 73 years, with a slight male predominance.
• Tumor sizes varied from 2 mm to 20 mm, with 12 cases detected by transesophageal echocardiography.

Findings:

• Neurologic events were observed in 4 patients, underscoring the embolic potential of these tumors.
• PFEs in the LAA and pulmonary vein ridge can be challenging to distinguish from cardiac thrombi on imaging.
• Histopathological confirmation is crucial for accurate diagnosis.

Implications:

• The findings emphasize the need to consider PFEs in the differential diagnosis of LAA masses, particularly in older patients presenting with embolic phenomena.
• Accurate imaging and prompt diagnosis are essential to prevent embolic complications associated with cardiac tumors.
• This study contributes to the understanding of PFEs in less typical locations and their clinical significance.