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LETTER TO EDITOR Table of Contents   
Year : 2009  |  Volume : 52  |  Issue : 3  |  Page : 444-446
Calcified amorphous tumor of the heart


Department of Pathology, Apollo Hospitals, 154/11, Bannerghatta Road, Bangalore - 560 076, Karnataka, India

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Date of Web Publication12-Aug-2009
 

How to cite this article:
Flynn A, Mukherjee G. Calcified amorphous tumor of the heart. Indian J Pathol Microbiol 2009;52:444-6

How to cite this URL:
Flynn A, Mukherjee G. Calcified amorphous tumor of the heart. Indian J Pathol Microbiol [serial online] 2009 [cited 2019 Nov 20];52:444-6. Available from: http://www.ijpmonline.org/text.asp?2009/52/3/444/55026


Sir,

We would like to report a case of an intracavitary calcified mass in a young man who presented with the chief complaint of frequent syncopal attacks. Echocardiography [Figure 1] revealed a pedunculated freely mobile calcified mass measuring 3 x 2 x 1cm arising from the chordae tendinae of the tricuspid valve in the right ventricle, severe tricuspid regurgitation with peak pulmonary pressure of 92 mm Hg and mild to moderate right heart dysfunction. Cardiac magnetic resonance imaging (MRI) confirmed the presence of the mass with the additional finding of a large thrombus completely occluding the left pulmonary artery and its lobar branches. Differential diagnosis of calcified cardiac fibroma was made at this time.

Surgery was performed and the mass and the thrombus were removed in toto.

The cardiac mass was sent for histopathology. Grossly, it was a grayish white firm tissue piece measuring 1.4 x 1.2 x 0.5 cm. Cut section showed a grayish white cut firm surface with a small cystic area filled with yellowish grey pultaceous contents. Entire tissue was processed. Microscopy revealed dense thick fibrocollagenous tissue with hyalinization and multiple foci of calcification. Mild scattered chronic inflammation was present. The cystic area contained plasma and degenerating blood cells along with some eosinophilic amorphous material resembling fibrin [Figure 2].

Final diagnosis of calcified amorphous tumor (CAT), right ventricle, was made.

Eleven cases of poorly characterized non-neoplastic endocardially- based calcified intracavitary cardiac masses have been seen in a 30-year study conducted in Mayo Clinic, USA, in which nine were clinically diagnosed as primary cardiac neoplasms.[1] Histopathology revealed all 11 to be CAT of heart. Mean age of occurrence was 52 years, though the youngest patient was 16 years old. [1]

Cardiac CATs represent degenerating intracavitary mural thrombi that can mimic neoplasms and cause symptoms due to embolization or obstruction. Surgical excision is generally curative. [2] Histologically, it is characterized by nodular calcium deposits over a matrix of fibrin and/or amorphous fibrin-like material, hyalinization, fibrosis, inflammatory cells and degenerating hematological elements. [3]

The pathogenesis of this lesion is obscure, but an origin from mural thrombi has been suggested. [1],[3]

Cardiac CAT may recur and enlarge following surgical excision.[2] Periodic postoperative follow-up with cardiac imaging studies may be indicated, particularly if there is evidence of incomplete excision. [2]

The presence of cardiac CAT in hemodialysis patients has been described. A case of a hemodialysis patient who had tumoral calcinosis of the upper extremities with concurrent CAT of heart has been reported from Japan. [4]

Blood tests revealed increased i-PTH and CaP product levels. Biochemical analysis done on the calcified tissue of upper limbs and that of heart revealed similar compositions of calcium phosphate and calcium carbonate. [4] Patients on hemodialysis appear to be at risk of developing CATs, among other cardiov ascular calcifications, due to potential abnormalities in calcium, PTH and vitamin D3 metabolism. [5]

The differential diagnoses of this lesion may include calcified myxomas or fibromas, calcified cardiac tuberculoma, tophaceous pseudogout and tumoral calcinosis. All these conditions were ruled out in our patient.

We are reporting this case for its rarity, as an unusual associated lesion seen in patients on hemodialysis and with pulmonary embolism and also to discuss contemporary management and the need for follow-up evaluations in such cases.

 
   References Top

1.Reynolds C, Tazelaar HD, Edwards WD. Calcified amorphous tumour of the heart (cardiac CAT). Hum Pathol 1997;28:601-6.  Back to cited text no. 1  [PUBMED]  
2.Fealey ME, Edwards WD, Reynolds CA, Pellikka PA, Dearani JA. Recurrent cardiac calcific amorphous tumour: t0 he CAT had a kitten. Cardiovasc Pathol 2007;16:115-8.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Gutierrez-Barrios A, Muriel-Cueto P, Lancho-Novillo C, Sanchon-Jaldon M. Calcified amorphous tumour of heart. Rev Esp Cardiol 2008;61:892-3.  Back to cited text no. 3    
4.Mikio M, Hatsuzo U, Toshihiko N, Yoshiki U, Juako M, Atsue K et al . A case of hemodialysis patient who had subcutaneous tumoural calcinosis of the upper extremities are calcified amorphous tumour of heart. J Jap Soc Dial Ther 2001;34:1427-33.  Back to cited text no. 4    
5.Tsuchihashi K, Takizawa H, Torii T, Ikeda R, Nakahara N, Yuda S, et al . Hypoparathyroidism potentiates cardiovascular complications through disturbed calcium metabolism: p0 ossible risk of vitamin D3 analog administration in dialysis patients with end - stage reveal disease. Nephron 2000;84:13-20.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Anita Flynn
C103, Chartered Coronet Apts., MICO Layout, Arekere, Bannerghatta Road, Bangalore - 560 076, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.55026

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    Figures

  [Figure 1], [Figure 2]

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