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A case of mesothelial/monocytic incidental cardiac excrescence and literature review.

Hu ZL, Lü H, Yin HL, Wen JF, Jin O - Diagn Pathol (2010)

Bottom Line: Mesothelial/monocytic incidental cardiac excrescence (MICE) is a rare entity which is an amalgam of mesothelial cells, histiocytes, and fibrin, often found occasionally during cardiac valve replacement.Routine and immunohistochemical stains and ultrastructure examination revealed the vegetation was predominantly composed of histocytes with scattered mesothelial cells.In fact nodular histiocytic/mesothelial hyperplasia (NHMH) is a similar lesion to MICE.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, Xiangya Medical School, Central South University, Changsha, Hunan Province, China. pjo7858@hotmail.com

ABSTRACT
Mesothelial/monocytic incidental cardiac excrescence (MICE) is a rare entity which is an amalgam of mesothelial cells, histiocytes, and fibrin, often found occasionally during cardiac valve replacement. We report a case in a 25-year-old Chinese female with serous mitral stenosis and patent foramen ovale. Routine and immunohistochemical stains and ultrastructure examination revealed the vegetation was predominantly composed of histocytes with scattered mesothelial cells. In fact nodular histiocytic/mesothelial hyperplasia (NHMH) is a similar lesion to MICE. MICE and NHMH could be unified, and NHMH may be a better choice.

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Related in: MedlinePlus

Soft tissue vegetation in pericardial sac. A, MICE is a mixture of histiocytes, mesothelial cells, fibrin, adipocytes, and inflammatory cells without a vascular network (Hematoxylin and eosin stain, × 100). B, Mesothelial gland-like structure are admixed with numerous histiocytes (Hematoxylin and eosin stain, ×200). C, The mesothelial cells are strongly immunoreactive for AE1/AE3 while the histiocytes are negative (DAB stain, ×400). D, The histiocytes are diffusely immunoreactive for CD68 while the mesothelial cells are negative (DAB stain, ×200).
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Figure 1: Soft tissue vegetation in pericardial sac. A, MICE is a mixture of histiocytes, mesothelial cells, fibrin, adipocytes, and inflammatory cells without a vascular network (Hematoxylin and eosin stain, × 100). B, Mesothelial gland-like structure are admixed with numerous histiocytes (Hematoxylin and eosin stain, ×200). C, The mesothelial cells are strongly immunoreactive for AE1/AE3 while the histiocytes are negative (DAB stain, ×400). D, The histiocytes are diffusely immunoreactive for CD68 while the mesothelial cells are negative (DAB stain, ×200).

Mentions: Gross examination showed two recognizable slightly thickened valve leaflets, and an erythematous soft tissue fragment measuring 1.2 × 1 × 0.3 cm. Microscopically the soft tissue fragment consisted of epithelial strips arranged in glandlike structures admixed with numerous histiocytes, delicate fibrin strands, empty vacuoles suggestive of lipid droplets or adipocytes, with few neutrophils infiltration (Fig. 1A and 1B). Occasionally, multinucleated cells could be observed. But mitosis was not observed in either cell population. Supporting stroma, including blood vessels, was not observed. The epithelial strips composed of cuboidal to low columnar cells, showing strong membranous immunostaining for cytokeratin AE1/AE3 (Fig. 1C) and cytokeratin 5/6, strong nuclear and cytoplasmic immunostaining for calretinin, and nuclear immunostaining for WT-1, supporting its mesothelial origin. The histiocytic component showed intense cytoplasmic immunostaining for CD68 (Fig. 1D) and lysozyme. Neither of cell components was stained with antibodies against S-100, synaptophysin, chromogranin, and CD34. The epithelial cells contained desomosome-like structures and microvilli in ultrastructure (Fig. 2), while rich histiocytoid cells showed renal-shape nuclei and a few cytoplasmic filaments.


A case of mesothelial/monocytic incidental cardiac excrescence and literature review.

Hu ZL, Lü H, Yin HL, Wen JF, Jin O - Diagn Pathol (2010)

Soft tissue vegetation in pericardial sac. A, MICE is a mixture of histiocytes, mesothelial cells, fibrin, adipocytes, and inflammatory cells without a vascular network (Hematoxylin and eosin stain, × 100). B, Mesothelial gland-like structure are admixed with numerous histiocytes (Hematoxylin and eosin stain, ×200). C, The mesothelial cells are strongly immunoreactive for AE1/AE3 while the histiocytes are negative (DAB stain, ×400). D, The histiocytes are diffusely immunoreactive for CD68 while the mesothelial cells are negative (DAB stain, ×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908560&req=5

Figure 1: Soft tissue vegetation in pericardial sac. A, MICE is a mixture of histiocytes, mesothelial cells, fibrin, adipocytes, and inflammatory cells without a vascular network (Hematoxylin and eosin stain, × 100). B, Mesothelial gland-like structure are admixed with numerous histiocytes (Hematoxylin and eosin stain, ×200). C, The mesothelial cells are strongly immunoreactive for AE1/AE3 while the histiocytes are negative (DAB stain, ×400). D, The histiocytes are diffusely immunoreactive for CD68 while the mesothelial cells are negative (DAB stain, ×200).
Mentions: Gross examination showed two recognizable slightly thickened valve leaflets, and an erythematous soft tissue fragment measuring 1.2 × 1 × 0.3 cm. Microscopically the soft tissue fragment consisted of epithelial strips arranged in glandlike structures admixed with numerous histiocytes, delicate fibrin strands, empty vacuoles suggestive of lipid droplets or adipocytes, with few neutrophils infiltration (Fig. 1A and 1B). Occasionally, multinucleated cells could be observed. But mitosis was not observed in either cell population. Supporting stroma, including blood vessels, was not observed. The epithelial strips composed of cuboidal to low columnar cells, showing strong membranous immunostaining for cytokeratin AE1/AE3 (Fig. 1C) and cytokeratin 5/6, strong nuclear and cytoplasmic immunostaining for calretinin, and nuclear immunostaining for WT-1, supporting its mesothelial origin. The histiocytic component showed intense cytoplasmic immunostaining for CD68 (Fig. 1D) and lysozyme. Neither of cell components was stained with antibodies against S-100, synaptophysin, chromogranin, and CD34. The epithelial cells contained desomosome-like structures and microvilli in ultrastructure (Fig. 2), while rich histiocytoid cells showed renal-shape nuclei and a few cytoplasmic filaments.

Bottom Line: Mesothelial/monocytic incidental cardiac excrescence (MICE) is a rare entity which is an amalgam of mesothelial cells, histiocytes, and fibrin, often found occasionally during cardiac valve replacement.Routine and immunohistochemical stains and ultrastructure examination revealed the vegetation was predominantly composed of histocytes with scattered mesothelial cells.In fact nodular histiocytic/mesothelial hyperplasia (NHMH) is a similar lesion to MICE.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, Xiangya Medical School, Central South University, Changsha, Hunan Province, China. pjo7858@hotmail.com

ABSTRACT
Mesothelial/monocytic incidental cardiac excrescence (MICE) is a rare entity which is an amalgam of mesothelial cells, histiocytes, and fibrin, often found occasionally during cardiac valve replacement. We report a case in a 25-year-old Chinese female with serous mitral stenosis and patent foramen ovale. Routine and immunohistochemical stains and ultrastructure examination revealed the vegetation was predominantly composed of histocytes with scattered mesothelial cells. In fact nodular histiocytic/mesothelial hyperplasia (NHMH) is a similar lesion to MICE. MICE and NHMH could be unified, and NHMH may be a better choice.

Show MeSH
Related in: MedlinePlus