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Infiltrating Lipoma of the Right Ventricle Involving the Interventricular Septum and Tricuspid Valve

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ABSTRACT

Cardiac lipoma, which are primary cardiac tumors, are rare entities often detected incidentally during imaging. There have been very few reports on the right ventricle (RV) lipoma. Here, we present a case of RV infiltrating lipoma involving the interventricular septum (IVS) and the tricuspid valve. Clinical symptoms, diagnostic procedures, multimodality imaging characteristics, and treatment are discussed, and the complete clinical data of this case and relevant details of retrospective literature are reviewed. The study described the case of a 48-year-old woman who suffered from occasional palpitation after exertion for 10 years. Imaging examinations, including echocardiography and cardiovascular magnetic resonance imaging (MRI), revealed a large mass adherent to the IVS and the right ventricular wall that was consistent with lipoma. The patient underwent surgical repair of the tricuspid valve and excision of the partial mass. The gross specimen revealed piles of 5 × 4 × 3 cm fragments with yellowish appearance and pathological results showed infiltrating lipoma.

Lipoma is often asymptomatic and diagnosed incidentally. Surgical excision is the main therapeutic intervention, which is always performed in cases of symptomatic lipoma or when malignancy is suspected. Multimodality imaging would be great help in the diagnosis of cardiac lipoma. Echocardiography is a convenient method for follow-up.

No MeSH data available.


Related in: MedlinePlus

Surgical and pathology findings show a yellowish tumor involving the chordae of tricuspid valve (arrow, A); the tumor is suspended by sutures (arrow, B). After resection of the tumor, a pile of tissue in the water (C); stained with hematoxylin and eosin (H&E) at 100 magnification: the tumor comprised mature adipocytes with entrapped myocardial cells (D). H&E = hematoxylin and eosin.
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Figure 4: Surgical and pathology findings show a yellowish tumor involving the chordae of tricuspid valve (arrow, A); the tumor is suspended by sutures (arrow, B). After resection of the tumor, a pile of tissue in the water (C); stained with hematoxylin and eosin (H&E) at 100 magnification: the tumor comprised mature adipocytes with entrapped myocardial cells (D). H&E = hematoxylin and eosin.

Mentions: The patient underwent surgery to remove the mass, under the diagnosis of RV tumor. During surgery, an irregular, yellowish, soft mass was found to be embedded in the IVS, and to occupy the RV cavity and the right ventricular apex. The tumor involved the chordae of the tricuspid septal and posterior leaflets. The tumor in the right ventricular apex was completely resected, but it was impossible to remove the entire tumor, because it was integrated with and partly immersed in the IVS. The tumor was removed in pieces, with part of the IVS and the tricuspid valve chordae (Figure 4A and B). Tricuspid valve repair was performed by construction of new chordae from the autologous pericardium. The reconstruction was performed with a clipped pericardium into the chordae, with one end attached to the appropriate papillary muscle and the other attached to the valve leaflet. The aim was to suspend the leaflet to prevent tricuspid regurgitation. Water was injected into the right ventricle to test the competence of the valve. The gross appearance of the surgically resected tumor was a pile of yellowish pieces of smooth tissue (Figure 4C). A microphotograph showed that the mass was composed of a cluster of mature adipocytes with entrapped myocardial cells. Removed tissue sections showed a massive infiltration of mature adipocytes with displacement of many pre-existing myocardial cells. Histological examination of the surgical specimen was used to determine the diagnosis of infiltrating lipoma of the RV (Figure 4D).


Infiltrating Lipoma of the Right Ventricle Involving the Interventricular Septum and Tricuspid Valve
Surgical and pathology findings show a yellowish tumor involving the chordae of tricuspid valve (arrow, A); the tumor is suspended by sutures (arrow, B). After resection of the tumor, a pile of tissue in the water (C); stained with hematoxylin and eosin (H&E) at 100 magnification: the tumor comprised mature adipocytes with entrapped myocardial cells (D). H&E = hematoxylin and eosin.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998283&req=5

Figure 4: Surgical and pathology findings show a yellowish tumor involving the chordae of tricuspid valve (arrow, A); the tumor is suspended by sutures (arrow, B). After resection of the tumor, a pile of tissue in the water (C); stained with hematoxylin and eosin (H&E) at 100 magnification: the tumor comprised mature adipocytes with entrapped myocardial cells (D). H&E = hematoxylin and eosin.
Mentions: The patient underwent surgery to remove the mass, under the diagnosis of RV tumor. During surgery, an irregular, yellowish, soft mass was found to be embedded in the IVS, and to occupy the RV cavity and the right ventricular apex. The tumor involved the chordae of the tricuspid septal and posterior leaflets. The tumor in the right ventricular apex was completely resected, but it was impossible to remove the entire tumor, because it was integrated with and partly immersed in the IVS. The tumor was removed in pieces, with part of the IVS and the tricuspid valve chordae (Figure 4A and B). Tricuspid valve repair was performed by construction of new chordae from the autologous pericardium. The reconstruction was performed with a clipped pericardium into the chordae, with one end attached to the appropriate papillary muscle and the other attached to the valve leaflet. The aim was to suspend the leaflet to prevent tricuspid regurgitation. Water was injected into the right ventricle to test the competence of the valve. The gross appearance of the surgically resected tumor was a pile of yellowish pieces of smooth tissue (Figure 4C). A microphotograph showed that the mass was composed of a cluster of mature adipocytes with entrapped myocardial cells. Removed tissue sections showed a massive infiltration of mature adipocytes with displacement of many pre-existing myocardial cells. Histological examination of the surgical specimen was used to determine the diagnosis of infiltrating lipoma of the RV (Figure 4D).

View Article: PubMed Central - PubMed

ABSTRACT

Cardiac lipoma, which are primary cardiac tumors, are rare entities often detected incidentally during imaging. There have been very few reports on the right ventricle (RV) lipoma. Here, we present a case of RV infiltrating lipoma involving the interventricular septum (IVS) and the tricuspid valve. Clinical symptoms, diagnostic procedures, multimodality imaging characteristics, and treatment are discussed, and the complete clinical data of this case and relevant details of retrospective literature are reviewed. The study described the case of a 48-year-old woman who suffered from occasional palpitation after exertion for 10 years. Imaging examinations, including echocardiography and cardiovascular magnetic resonance imaging (MRI), revealed a large mass adherent to the IVS and the right ventricular wall that was consistent with lipoma. The patient underwent surgical repair of the tricuspid valve and excision of the partial mass. The gross specimen revealed piles of 5 × 4 × 3 cm fragments with yellowish appearance and pathological results showed infiltrating lipoma.

Lipoma is often asymptomatic and diagnosed incidentally. Surgical excision is the main therapeutic intervention, which is always performed in cases of symptomatic lipoma or when malignancy is suspected. Multimodality imaging would be great help in the diagnosis of cardiac lipoma. Echocardiography is a convenient method for follow-up.

No MeSH data available.


Related in: MedlinePlus