Elsevier

Cardiovascular Pathology

Volume 23, Issue 6, November–December 2014, Pages 369-371
Cardiovascular Pathology

Clinical Case Report
Calcified amorphous tumors (CATs) of the heart

https://doi.org/10.1016/j.carpath.2014.07.003Get rights and content

Abstract

Intracavitary cardiac masses include neoplastic and nonneoplastic masses, which may share overlapping clinical symptomatology, physical examination findings, and or imaging characteristics. Definitive diagnosis of a cardiac mass is usually made on surgical excision and histological examination. In this article, we focus on one of the rare nonneoplastic cardiac mass, namely, calcified amorphous tumors. We present a series of three patients, an 80-year-old female who presented to the hospital for evaluation of a near syncope event, a 69-year-old female who presented for evaluation of palpitations, and a 60-year-old female who presented for evaluation of shortness of breath, who were found to have calcified amorphous tumors. We have also provided a relevant review of the literature on this topic.

Introduction

The term calcified amorphous tumor (CAT) was coined for the first time in 1997 by Reynold et al. after a thorough review of clinical, imaging, and histological characteristics of 11 patients who had presented with intracavitary cardiac masses at Mayo Clinic between 1965 and 1994 [1]. The masses on histological examination consisted of calcification nodules with the background of amorphous material [1]. Since then, the number of reported CATs in the literature remains low. Little is known about the incidence, etiology, and pathogenesis of the CATs. In this article, we present a series of three patients who presented with intracavitary cardiac masses that upon histological examination after surgical excision were found to be CATs. A comprehensive review of the literature on this topic is also provided.

Section snippets

Case 1

An 80-year-old female with a past medical history of hypertension, hyperlipidemia, coronary artery disease status postcoronary artery bypass grafting, and right middle lobectomy for poorly differentiated adenocarcinoma of lung presented to the hospital with a near-syncope event. A two-dimensional (2D) transthoracic echocardiography (Echo) and a subsequent trans-esophageal echocardiogram (TEE) demonstrated a large friable mass prolapsing across the aortic valve; no wall motion abnormalities were

Discussion

The true incidence of the CATs is unknown, but it appears to comprise only a very small portion of the nonneoplastic intracavitary cardiac masses with around 30 cases reported in the literature [2]. In the study by Reynolds et al., the CATs diagnosis was more frequent among female patients, and the mean age at the diagnosis was around 52 [1]. The exact etiology of CATs remains obscure; the factors that would affect the Virchow's triad, that is, endothelial damage, stasis, and hypercoagulable

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Funding: None.

Conflicts of Interest: Authors have no conflicts of interest to declare.

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