Calcified amorphous tumors (CATs) of the heart

Approach to Management of Cardiac Calcified Amorphous Tumor

A 76-year-old female with a known medical history of treated essential hypertension, hyperlipidemia, and obesity presented to her primary care provider for 2 months of worsening left-sided vision loss. Ophthalmologic evaluation demonstrated a left retinal artery branch occlusion leading to echocardiographic evaluation which revealed a large mobile echodensity on the mitral valve. Given specific clinical features and echocardiographic characteristics, the suspicion was highest for calcified amorphous tumor (CAT). Excision of this mass confirmed the diagnosis of CAT. There is currently clinical equipoise in literature regarding the best treatment strategy for these tumors therefore a multidisciplinary approach should be used to formulate individualized treatment plans.

Cardiac calcified amorphous tumor in a patient with lung cancer

BACKGROUND

Calcified amorphous tumor of the heart is a rare non-neoplastic cardiac mass composed of calcified nodules over amorphous fibrous tissue with degeneration and some chronic inflammation. Calcified amorphous tumor is often associated with mitral annular calcification in patients with end-stage renal disease on dialysis. However, the exact etiology of calcified amorphous tumors remains uncertain.

CASE PRESENTATION

A 77-year-old female with lung cancer showed a tumor with large mobility in the left ventricular outflow tract on transthoracic echocardiography. She had mitral annular calcification, although her renal function was normal. The tumor was excised surgically. Pathologically, the extracted specimen consisted of a calcified lesion without tumor tissue and was diagnosed as a calcified amorphous tumor.

CONCLUSIONS

As the patient had no other risk factors for calcified amorphous tumor except mitral annular calcification, we considered the association of blood coagulation abnormalities due to cancer-related thrombosis. This case suggests that calcified amorphous tumors may be associated with malignant tumors.

A Man with an Usual Cause of Mitral Insufficiency

Cardiac calcified amorphous tumors (CAT) are rarely encountered nonneoplastic tumors that may arise within any cardiac chamber. Involvement of the mitral valve causing pathology is even less frequently reported. We report the case of a CAT arising on the posterior mitral valve leaflet resulting in chordal rupture and severe mitral insufficiency. Multi-modality imaging was performed before definitive diagnosis through histology. We review the morphological features encountered in our case to highlight the diagnostic difficulties and raise awareness of this peculiar pathology.

Multiple cardiac calcified amorphous tumors with morphologically different characteristics complicated by aortic regurgitation: a case report

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.

The First Report of Calcified Amorphous Tumor Associated with Infective Endocarditis: A Case Report and Review of Literature

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.

Cardiac calcified amorphous tumour associated with multiple myeloma

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.

A Case of Cardiac Calcified Amorphous Tumor Presenting with Concomitant ST-Elevation Myocardial Infarction and Occipital Stroke and a Brief Review of the Literature

Cardiac calcified amorphous tumor (CAT) is an extremely rare benign intracavitary tumor of the heart. It may mimic other cardiac tumors and can present with signs or symptoms of systemic embolization. There are limited data regarding CAT in the literature. We report a case of a 68-year-old woman with a cardiac CAT and mitral annular calcification (MAC), who presented with acute ST-elevation myocardial infarction (STEMI) and occipital stroke. After extensive review of the literature, we believe that this case is possibly the first description of a cardiac CAT presenting with STEMI. The CAT was surgically removed, and the diagnosis was confirmed by histology. The patient tolerated the surgery and reported no events at 6-month follow-up.

Cardiac Calcified Amorphous Tumors in a Patient with Hemodialysis for Diabetic Nephropathy

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.

Calcified Amorphous Tumor Causing Shower Embolism to the Brain: A Case Report with Serial Echocardiographic and Neuroradiologic Images and a Review of the Literature

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.

Cardiac Calcified Amorphous Tumor of the Mitral Valve Presenting as Transient Ischemic Attack

Cardiac calcified amorphous tumors (CATs) are an extremely rare nonneoplastic intracardiac masses. They have been reported in the literature in only a few cases. Thus, the incidence, pathogenesis, and best approach to the treatment are not certain. We report a case of CATs on the atrial surface of the anterior mitral valve leaflet in a 37-year-old female who was diagnosed by histopathological examination after surgical removal.

Calcified amorphous tumor of the heart in a hemodialysis patient

We report a case of calcified amorphous tumor (CAT) of the heart in a 60-year-old Japanese man on hemodialysis. Because the masses in the mitral annulus developed during two-year echocardiographic follow-up, he underwent surgical resection with mitral valve replacement. Histological examination showed that the tumor contained multiple calcified nodules, which confirmed the diagnosis of CAT. This case report reinforces the need to deeply and periodically investigate for cardiac involvement of CAT in all patients on hemodialysis.

Surgical removal of calcified amorphous tumor localized to mitral valve leaflet without mitral annular calcification

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.

Cardiac calcified amorphous tumor in a hemodialysis patient

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.

Cardiac calcified amorphous tumor: A systematic review of the literature

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.