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Multiple calcified amorphous tumours of the heart
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  1. Sonoko Eizawa,
  2. Yoshihisa Morimoto,
  3. Akitoshi Yamada and
  4. Masanobu Sato
  1. Cardiovascular Surgery, Kita-Harima Medical Center, Ono, Japan
  1. Correspondence to Dr Yoshihisa Morimoto; yoshimor{at}gmail.com

http://dx.doi.org/10.1136/bcr-2023-254823

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    Description

    The cardiac calcified amorphous tumour (CAT), which is originally described by Reynolds and colleagues,1 is a very rare non-neoplasmic cardiac mass. Since only few reports have been published, the cause, clinical manifestations and treatment of this tumour remain unknown.

    A previously healthy woman in her 80s presented to the ophthalmology clinic of our institution with a 2-week history of acute painless vision loss in her left eye. Dilated fundus examination of her left eye revealed a visible motile embolus in the branch of the retinal artery bifurcation. A diagnosis of branch retinal artery occlusion was made.

    Ttransthoracic and transoesophageal echocardiography and CT angiography (figure 1A–C) demonstrated diffuse calcification affecting the mitral annulus and mitral leaflets and a pedunculated, mobile tumour that originated from the annulus of the posterior leaflet of the mitral valve. The primary and secondary tumours were hyperechoic and measured 19×5 mm and 5×2 mm, respectively. Mitral regurgitation was not detected, and the left ventricle systolic function was not depressed with a volumetric calculated ejection fraction of 65%. ECG revealed normal sinus rhythm and no arrhythmia. Laboratory data showed no evidence of an inflammatory reaction and renal dysfunction.

    Figure 1
    Figure 1

    Diffuse calcification affecting the mitral annulus and mitral leaflets and a pedunculated, mobile tumour that originated from the annulus of the posterior leaflet of the mitral valve. (A) Transoesophageal echocardiography; (B) transoesophageal echocardiography three-dimensional imaging; (C) CT angiography and (D,E) endoscopic surgical view.

    To prevent any further embolic events, emergency surgery was performed. Considering her general condition, we decided to perform endoscopic tumour resection via right thoracotomy. After the left atrial incision, the mitral valve and tumours were clearly visualised by endoscopy (figure 1D,E and video 1). Although the mitral valve showed a little degenerative change, no evidence of infectious endocarditis was observed. Two soft and fragile tumours were easily removed by using forceps without exerting any force. This patient is alive and well with no evidence of tumour recurrence 6 months after the operation.

    Video 1 Two soft and fragile tumours were easily removed by using forceps without exerting any force

    Histologically, the lesions were similar and composed of nodular deposits or flecks of calcium within a background of eosinophilic, amorphous and sometimes fibrillar material (figure 2). Based on the pathological findings and the irregularly shaped calcific cardiac mass demonstrated by CT, the patient was diagnosed with a CAT of the heart.

    Figure 2
    Figure 2

    Histologically, the lesions were similar and composed of nodular deposits or flecks of calcium within a background of eosinophilic, amorphous and sometimes fibrillar material.

    Cardiac CAT is a rare non-neoplastic cardiac mass that mimics malignancy and causes symptoms due to obstruction or embolisation of calcific fragments.1 2 Surgical excision is the treatment of choice in suitable candidates and can be curative. Postoperative recurrence of CAT has been reported, hence patients should be followed vigilantly.3

    Learning points

    • We presented a case of multiple calcified amorphous tumours of the heart.

    • Endoscopic tumour resection via a right thoracotomy is safe and feasible, with a potentially improved surgical view.

    • Postoperative recurrence of CAT has been reported, hence patients should be followed vigilantly.

    Ethics statements

    Patient consent for publication

    References

    1. ↵
      1. Reynolds C,
      2. Tazelaar HD,
      3. Edwards WD
      . Calcified amorphous tumor of the heart (cardiac cat). Hum Pathol 1997;28:601–6. doi:10.1016/s0046-8177(97)90083-6
      OpenUrlCrossRefPubMedWeb of Science
    2. ↵
      1. Lewin M,
      2. Nazarian S,
      3. Marine JE, et al
      . Fatal outcome of a calcified amorphous tumor of the heart (cardiac cat). Cardiovasc Pathol 2006;15:299–302. doi:10.1016/j.carpath.2006.05.004
      OpenUrlCrossRefPubMedWeb of Science
    3. ↵
      1. Fealey ME,
      2. Edwards WD,
      3. Reynolds CA, et al
      . Recurrent cardiac calcific amorphous tumor: the cat had a kitten. Cardiovasc Pathol 2007;16:115–8. doi:10.1016/j.carpath.2006.09.002
      OpenUrlCrossRefPubMedWeb of Science

    Footnotes

    • Contributors SE was responsible for critical revision of the article, writing, editing and data collection. YM contributed to original drafting, design and implementation of the research, and data collection. AY and MS finalised the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.