Primary Cardiac Angiofibroma
A 57 year-old female without any medical history was admitted for a left ventricular (LV) tumor that was discovered incidentally. The tumor was found by echocardiography which was performed for the baseline evaluation of hypertension.\nThe echocardiography showed a round-shaped, immobile and echogenic mass attached at the LV apex. The valve and LV functions were normal ().\nCardiac MRI was performed to determine the tumor's tissue type and its relations to other cardiac structures. It showed a slightly high signal intensity on both T1 and T2 weighted images. The gadoliniumenhanced cardiac MRI showed a hypoperfused tumor core and peripheral enhancement ().\nIn addition, the lesion showed the centripetal enhancement pattern during the first-pass infusion of the gadolium-containing contrast (). The features of such are associated with the vascular tumors such as liver hemangioma.\nThe mass showed peripheral enhancement with the central sparing on the delayed enhanced imaging (). It suggested that the tumor had an abundant fibrous content as well as a vascular content.\nIn this patient, the initial preoperative diagnosis of the mass was fibrous tumor of the LV apex. The patient was referred to a cardiac surgeon for the removal of the cardiac mass. Intraoperatively, a whitish, solid mass was detached from the base of the anterolateral papillary muscle ().\nOn the histologic evaluation, it showed a somewhat well-demarcated collagenous mass arising from the myocardium (, arrows). The high-power view showed multiple irregular vascular channels () with intervening dense collagen deposition in the mass. The desmin immunohistochemistry and trichrome staining confirmed that the stroma consisted of dense collagenous tissue, not smooth muscle (). From these histologic findings, we diagnosed the mass as angiofibroma. The patient is currently doing well without any evidence of recurrence at the 2-year follow-up.