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Sakurai H, Someya T, Yamamoto S, Ito E, Kuroki H, Shirai T. Multiple cardiac calcified amorphous tumors with morphologically different characteristics complicated by aortic regurgitation: a case report. GENERAL THORACIC AND CARDIOVASCULAR SURGERY CASES 2023; 2:31. [PMID: 39517046 PMCID: PMC11533491 DOI: 10.1186/s44215-022-00028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 11/22/2022] [Indexed: 11/16/2024]
Abstract
BACKGROUND Cardiac calcified amorphous tumors (CATs) are non-neoplastic cardiac tumors of unknown origin and etiology. Several simultaneous CATs rarely occur in multiple cardiac chambers. Although CATs carry a benign prognosis, they have a risk of complications such as systemic embolism. CASE PRESENTATION We report the case of a 79-year-old woman with two CATs and aortic regurgitation due to perforations of aortic cusps. She underwent surgical tumor resection with aortic valve replacement. The CATs were macroscopically and histologically different, which may suggest different developmental stages. One CAT was in the left atrium; it was less mobile and had nodular calcifications within dense fibrous tissue. The other CAT was in the left ventricular outflow tract; it was highly mobile, with nodular calcifications surrounded by amorphous fibrin and sanguineous deposits. The highly mobile CAT mechanically damaged the aortic cusps and caused perforations. The patient has survived over 2 years with no recurrence of the cardiac masses on echocardiography. CONCLUSION The patient underwent surgical resection for two CATs. The tumors occurred in different areas and had different macroscopic and histological characteristics. We recommend early resection for highly mobile CATs because of the high risks of embolization and injuries to the surrounding tissues.
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Affiliation(s)
- Hironobu Sakurai
- Department of Cardiothoracic Surgery, Ome Municipal General Hospital, 4-16-5, Higashiome, Ome City, Tokyo, 198-0042, Japan.
| | - Takeshi Someya
- Department of Cardiothoracic Surgery, Ome Municipal General Hospital, 4-16-5, Higashiome, Ome City, Tokyo, 198-0042, Japan
| | - Satoshi Yamamoto
- Department of Cardiothoracic Surgery, Ome Municipal General Hospital, 4-16-5, Higashiome, Ome City, Tokyo, 198-0042, Japan
| | - Eisaku Ito
- Department of Pathology, Ome Municipal General Hospital, 4-16-5, Higashiome, Ome City, Tokyo, Japan
| | - Hidehito Kuroki
- Department of Cardiothoracic Surgery, Ome Municipal General Hospital, 4-16-5, Higashiome, Ome City, Tokyo, 198-0042, Japan
| | - Toshizumi Shirai
- Department of Cardiothoracic Surgery, Ome Municipal General Hospital, 4-16-5, Higashiome, Ome City, Tokyo, 198-0042, Japan
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Ushioda R, Shirasaka T, Kikuchi S, Kamiya H, Kanamori T. Calcified amorphous tumor located on a severely calcified mitral annulus in a patient with normal renal function. J Surg Case Rep 2022; 2022:rjab608. [PMID: 35079337 PMCID: PMC8784176 DOI: 10.1093/jscr/rjab608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/15/2021] [Indexed: 11/12/2022] Open
Abstract
A calcified amorphous tumor (CAT) of the heart is a rare, nonneoplastic, intracavitary cardiac mass. Histological examination shows that it contains calcified and amorphous fibrous material with underlying chronic inflammation. Surgical excision is generally recommended to avoid future embolism. The risk of embolism has been reported to be especially high in mitral-annular-calcification-related CAT, which constitutes a subgroup of CAT that is often associated with end-stage renal disease. A case of a CAT attached to the anterior annulus of the mitral valve that was easily removed with a light touch of the forceps through aortotomy is reported.
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Affiliation(s)
| | | | | | - Hiroyuki Kamiya
- Correspondence address. Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan. Tel: +81-166-68-2490; Fax: +81-166-68-2499; E-mail:
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3
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Okazaki A, Oyama Y, Hosokawa N, Ban H, Miyaji Y, Moody S. The First Report of Calcified Amorphous Tumor Associated with Infective Endocarditis: A Case Report and Review of Literature. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e922960. [PMID: 32374721 PMCID: PMC7226926 DOI: 10.12659/ajcr.922960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Calcified amorphous tumor (CAT) of the heart is a rare non-neoplastic intracardiac mass, which is composed of calcium deposition surrounded by amorphous fibrous tissue. The clinical presentation of cardiac CAT resembles that of other cardiac tumors or vegetation, though there is no previous report of a CAT complicated with infective endocarditis. CASE REPORT A 67-year-old male with a history of end stage renal failure and gastric cancer who was on adjuvant chemotherapy presented with a cardiac mass. The mass was resected and diagnosed as CAT pathologically. Two separate sets of blood cultures were positive for Enterococcus faecalis, thus, the patient was diagnosed with infective endocarditis. Antibiotic treatment was continued for 6 weeks after surgery, and the patient recovered uneventfully. However, he died from a complication of his gastric cancer 5 months later. CONCLUSIONS This is the first report of CAT associated with infective endocarditis. Blood cultures should be obtained to differentiate infective endocarditis or CAT with infectious endocarditis from CAT alone, because CAT with infective endocarditis may present atypically and may be more likely to require antibiotic treatment along with surgery.
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Affiliation(s)
- Aiko Okazaki
- Department of Oncology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Yu Oyama
- Department of Oncology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Naoto Hosokawa
- Department of Infectious Diseases, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Hirokazu Ban
- Department of Infectious Diseases, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Yasutomo Miyaji
- Department of Oncology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Sandra Moody
- Department of Clinical Education, Kameda Medical Center, Kamogawa, Chiba, Japan
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Yamanaka T, Fukatsu T, Uchimuro T, Takanashi S. Cardiac calcified amorphous tumour associated with multiple myeloma. BMJ Case Rep 2020; 13:13/4/e233679. [PMID: 32350053 DOI: 10.1136/bcr-2019-233679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report an 86-year-old woman who was diagnosed with multiple myeloma (MM) and was receiving chemotherapy since the age of 82. A high echoic mass attached to the mitral valve was observed on transthoracic echocardiography 4 years after the treatment. The possibility of malignancy could not be ruled out, and hence, the mass was excised surgically. Pathologically, most of the mass consisted of calcified lesion without tumour tissue, and these findings were not inconsistent with calcified amorphous tumour (CAT). This case suggests that CAT may be associated with MM and has been reported after a thorough literature review.
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Orozco-Hernandez EJ, Argueta-Sosa EE, Mauchley D, Xie R, Mitchell CB, Self DM, Davies JE. Left ventricular myxoma: A contractile mass causing intracavitary obstruction and severe pulmonary hypertension. J Card Surg 2019; 34:1127-1129. [PMID: 31374579 DOI: 10.1111/jocs.14195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cardiac myxomas can be fatal and left ventricular (LV) myxomas with papillary muscle and mitral valve (MV) involvement are rare. The following case is that of a 55-year-old woman who developed signs and symptoms of pulmonary hypertension. Imaging revealed a contractile mass in the LV that was in continuum with the papillary muscles and affected MV function. Her clinical course, radiologic, and hemodynamic findings are discussed. Finally, her surgical extraction technique is described in addition to potential complications encountered.
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Affiliation(s)
- Erik J Orozco-Hernandez
- Division of Cardiovascular Surgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Erwin E Argueta-Sosa
- Division of Cardiovascular Diseases, University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - David Mauchley
- Division of Cardiovascular Surgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Rongbing Xie
- Division of Cardiovascular Surgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Chace B Mitchell
- Division of Cardiovascular Surgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Dwight M Self
- Division of Cardiovascular Surgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - James E Davies
- Division of Cardiovascular Surgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama
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Yoshimura S, Kawano H, Minami T, Tsuneto A, Nakata T, Koga S, Ikeda S, Hayashi T, Maemura K. Cardiac Calcified Amorphous Tumors in a Patient with Hemodialysis for Diabetic Nephropathy. Intern Med 2017; 56:3057-3060. [PMID: 28943588 PMCID: PMC5725860 DOI: 10.2169/internalmedicine.9057-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Calcified amorphous tumor (CAT) is a rare, non-neoplastic tumor involving calcium deposition in amorphous materials. Although its etiology is unknown, cases have frequently been reported in patients with hemodialysis for chronic kidney disease. We herein describe a case of cardiac CAT in a 64-year-old woman who had been on hemodialysis for diabetic nephropathy for 20 years, and the findings of the present patient, in association with the findings of previous case reports, suggest that end-stage renal disease seems to play an important role in the onset of CAT, especially in CAT formation at the mitral annulus, which appears to differ from CAT occurring at other sites.
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Affiliation(s)
- Satoshi Yoshimura
- Department of Cardiology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Hiroaki Kawano
- Department of Cardiology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Takako Minami
- Department of Cardiology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Akira Tsuneto
- Department of Cardiology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Tomoo Nakata
- Department of Cardiology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Seiji Koga
- Department of Cardiology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Satoshi Ikeda
- Department of Cardiology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | | | - Koji Maemura
- Department of Cardiology, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Singu T, Inatomi Y, Yonehara T, Ando Y. Calcified Amorphous Tumor Causing Shower Embolism to the Brain: A Case Report with Serial Echocardiographic and Neuroradiologic Images and a Review of the Literature. J Stroke Cerebrovasc Dis 2017; 26:e85-e89. [PMID: 28318955 DOI: 10.1016/j.jstrokecerebrovasdis.2017.02.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/29/2017] [Accepted: 02/15/2017] [Indexed: 11/24/2022] Open
Abstract
An 89-year-old woman with chronic atrial fibrillation, hypertension, chronic heart failure, and dementia was admitted to our hospital due to multiple small cerebral and cerebellar infarctions. Transthoracic echocardiogram revealed a floating calcified mass lesion arising from the endocardium of the posterior portion of the mitral annulus with mitral annular calcification. Furthermore, the mass had a heterogeneity of the echogenicity. The mass was diagnosed as a calcified amorphous tumor based on specific echocardiographic features. Serial echocardiograms showed shrinkage and disappearance of the mass, and magnetic resonance image revealed new infarction in the left occipital lobe. Embolization of the mass appeared to cause systemic embolism.
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Affiliation(s)
- Takaomi Singu
- Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
| | - Yuichiro Inatomi
- Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Toshiro Yonehara
- Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Masuda S, Motoyoshi N, Ito K, Hayatsu Y, Akiyama M, Kawamoto S, Saiki Y. Surgical removal of calcified amorphous tumor localized to mitral valve leaflet without mitral annular calcification. Surg Case Rep 2015; 1:39. [PMID: 26943404 PMCID: PMC4747926 DOI: 10.1186/s40792-015-0040-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 04/13/2015] [Indexed: 11/10/2022] Open
Abstract
A cardiac calcified amorphous tumor (CAT) localized to the mitral valve leaflet without mitral annular calcification (MAC) is a rare entity. We report a case of a 69-year-old woman with such a condition, who underwent successful excision of the tumor and mitral valvuloplasty using a glutaraldehyde-treated autologous pericardium. During 38 months of follow-up, no recurrence of a cardiac mass has been recognized. This report addresses questions on the surgical indication for CAT, particularly in cases without MAC, and reviews CATs of the mitral valve.
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Affiliation(s)
- Shinya Masuda
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aoba-ku, Sendai, 980-8574, Japan.
| | - Naotaka Motoyoshi
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aoba-ku, Sendai, 980-8574, Japan.
| | - Koki Ito
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aoba-ku, Sendai, 980-8574, Japan.
| | - Yukihiro Hayatsu
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aoba-ku, Sendai, 980-8574, Japan.
| | - Masatoshi Akiyama
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aoba-ku, Sendai, 980-8574, Japan.
| | - Shunsuke Kawamoto
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aoba-ku, Sendai, 980-8574, Japan.
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aoba-ku, Sendai, 980-8574, Japan.
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Seo H, Fujii H, Aoyama T, Sasako Y. Cardiac calcified amorphous tumor in a hemodialysis patient. Asian Cardiovasc Thorac Ann 2015; 24:461-3. [PMID: 25742783 DOI: 10.1177/0218492315574795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a case of cardiac calcified amorphous tumor, a rare intracardiac non-neoplastic tumor, in a hemodialysis patient. A 72-year-old woman with no history of thromboembolic, malignant, or inflammatory disease presented with dyspnea. Echocardiography revealed a highly echoic, slightly mobile mass with an acoustic shadow originating from the mitral subvalvular apparatus, extending to the left ventricular outflow tract. She underwent surgical resection of the mass through the aortic valve, which was easily excised from the papillary muscle and chordae tendineae. Histopathologic examination revealed nodular calcium deposits on a background of amorphous degenerated fibrin material, consistent with calcified amorphous tumor.
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Affiliation(s)
- Hiroyuki Seo
- Department of Cardiovascular Surgery, Japan Community Health Care Organization, Osaka Hospital, Osaka, Japan
| | - Hiromichi Fujii
- Department of Cardiovascular Surgery, Japan Community Health Care Organization, Osaka Hospital, Osaka, Japan
| | - Takanobu Aoyama
- Department of Cardiovascular Surgery, Japan Community Health Care Organization, Osaka Hospital, Osaka, Japan
| | - Yoshikado Sasako
- Department of Cardiovascular Surgery, Japan Community Health Care Organization, Osaka Hospital, Osaka, Japan
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de Hemptinne Q, de Cannière D, Vandenbossche JL, Unger P. Cardiac calcified amorphous tumor: A systematic review of the literature. IJC HEART & VASCULATURE 2015; 7:1-5. [PMID: 28785635 PMCID: PMC5497183 DOI: 10.1016/j.ijcha.2015.01.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/20/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Calcified amorphous tumor (CAT) of the heart is a rare non-neoplastic intracavitary cardiac mass. Several case reports have been published but large series are lacking. OBJECTIVE To determine clinical features, current management and outcomes of this rare disease. DESIGN A systematic review of all articles reporting cases of CAT in order to perform a pooled analysis of its clinical features, management and outcomes. DATA SOURCES An electronic search of all English articles using PUBMED was performed. Further studies were identified by cross-referencing from relevant papers. INCLUSION CRITERIA We restricted inclusion to articles reporting cases of CAT in the English language literature published up to July 2014. DATA EXTRACTION One author performed data extraction using predefined data fields. RESULTS A total of 27 articles, reporting 42 cases of CAT were found and included in this review. CONCLUSION In this review, the most frequent presenting symptoms were dyspnea and embolic events. Mitral valve and annulus were the most frequent location of CAT. Surgery was most of the time required to confirm diagnosis, and was relatively safe. Overall outcome after surgical resection was good.
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Affiliation(s)
- Quentin de Hemptinne
- Department of Cardiology, CHU Saint-Pierre, Université Libre de Bruxelles, Rue Haute, 322-1000 Brussels, Belgium
| | - Didier de Cannière
- Department of Cardiac Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Rue Haute, 322-1000 Brussels, Belgium
| | - Jean-Luc Vandenbossche
- Department of Cardiology, CHU Saint-Pierre, Université Libre de Bruxelles, Rue Haute, 322-1000 Brussels, Belgium
| | - Philippe Unger
- Department of Cardiology, CHU Saint-Pierre, Université Libre de Bruxelles, Rue Haute, 322-1000 Brussels, Belgium
- Corresponding author. Tel.: + 32 25353351; fax: + 32 25353362.
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de Hemptinne Q, Bar JP, de Cannière D, Unger P. Swinging cardiac calcified amorphous tumour arising from a calcified mitral annulus in a patient with normal renal function. BMJ Case Rep 2015; 2015:bcr-2014-207401. [PMID: 25568275 DOI: 10.1136/bcr-2014-207401] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 67-year-old man was referred to our institution for the management of a left-sided intracardiac mass discovered following two cardioembolic events. Imaging studies revealed a highly mobile mass attached to the ventricular side of a calcified mitral annulus. The mass had not been present on echocardiography 1 year earlier. Surgical resection was performed. Microscopic examination confirmed the diagnosis of a calcified amorphous tumour. The postoperative course was unremarkable, and the patient remains asymptomatic and without recurrence of a mass or neurological event after a 12-month follow-up.
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Affiliation(s)
- Quentin de Hemptinne
- Department of Cardiology, CHU Saint-Pierre-Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Paul Bar
- Department of Cardiology, Hôpital Molière-Longchamp-Université Libre de Bruxelles, Brussels, Belgium
| | - Didier de Cannière
- Department of Cardiac Surgery, CHU Saint-Pierre-Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe Unger
- Department of Cardiology, CHU Saint-Pierre-Université Libre de Bruxelles, Brussels, Belgium
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