Salyer W R, Page D L, Hutchins G M
Am Heart J. 1975 Jan;89(1):4-17. doi: 10.1016/0002-8703(75)90003-4.
A morphologic study of 466 cardiac mural thrombi, 66 examples of nonbacterial thrombotic endocarditis, 25 myxomas, and 12 papillary endocardial lesions was performed. It appeared that three different sequences of organization of endocardial thrombi are possible. (1) Ordinary mural thrombi are converted into a flat, fibrous scar by fibroblast proliferation and collagen and elastic fiber deposition. (2) Papillary endocardial lesions develop from non bacterial thrombotic endocarditis as additional thrombus material is acquired in some foci and lost in others. No ingrowth of granulation tissue occurs at the base of these lesions. The thrombus material of the papillae is gradually replaced by fibrous tissue, and the lesion eventually is identical to a large Lambl's excrescence. (3) Myxomas enlarge in part as do the papillary endocardial lesions. In addition, their size increases as a result of influx into the myxoma of fluid from the basal granulation tissue. Although myxomas cannot be differentiated from ordinary mural thrombi on the basis of the cellular and ground substance components, their mode of development results in a distinctive appearance. The mature lesion is composed of three zones: a basal layer of small vascular channels, undifferentiated mesenchymal cells, and ground substance; a middle, acellular zone of ground substance; and a cortical layer of mesenchymal cells. The peculiar arrangement of endothelial cells and undifferentiated mesenchymal cells, the examples of apparent atrial wall invasion, and the cases of embolic "metastases" provide no conclusive evidence of neoplasia, since these features may also be seen with ordinary mural thrombi.
对466例心脏壁血栓、66例非细菌性血栓性心内膜炎、25例黏液瘤和12例乳头样心内膜病变进行了形态学研究。结果显示，心内膜血栓可能有三种不同的机化顺序。(1) 普通壁血栓通过成纤维细胞增殖以及胶原和弹性纤维沉积转化为扁平的纤维瘢痕。(2) 乳头样心内膜病变由非细菌性血栓性心内膜炎发展而来，一些病灶获取额外的血栓物质，而另一些病灶则丢失血栓物质。这些病变底部无肉芽组织长入。乳头的血栓物质逐渐被纤维组织替代，最终病变与大的兰布尔赘生物相同。(3) 黏液瘤部分地像乳头样心内膜病变一样增大。此外，由于来自基底肉芽组织的液体流入黏液瘤，其大小也会增加。虽然黏液瘤在细胞和基质成分上无法与普通壁血栓区分，但它们的发展方式导致了独特的外观。成熟病变由三个区域组成：一个由小血管通道、未分化间充质细胞和基质构成的基底层；一个中间的无细胞基质区；以及一个间充质细胞的皮质层。内皮细胞和未分化间充质细胞的特殊排列、明显的心房壁侵犯实例以及栓塞 “转移” 病例均未提供肿瘤形成的确凿证据，因为这些特征在普通壁血栓中也可见到。
