Nakamaru Ryo, Oe Hiroki, Iwakura Katsuomi, Masai Takafumi, Fujii Kenshi
Department of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, 5300001, Japan.
J Med Case Rep. 2017 Jul 18;11(1):195. doi: 10.1186/s13256-017-1337-9.
Calcified amorphous tumor of the heart is a rare, non-neoplastic cardiac mass characterized by nodular calcium in the background of amorphous degenerating fibrinous material. Clinical diagnosis of calcified amorphous tumor can be difficult, and current single imaging techniques do not specifically differentiate calcified amorphous tumor from other cardiac tumors such as calcified atrial myxoma, calcified thrombi, or vegetation. Complete surgical resection is the treatment of choice for both symptom improvement and prevention of embolization, as well as for pathological diagnosis.
A 70-year-old Asian man with end-stage renal disease complained of chest discomfort during exercise. He had no history of thromboembolism or endocarditis. A transthoracic echocardiogram revealed mitral annular calcification as well as a highly mobile mass (8 × 6 mm) attached to the ventricular side of the posterior mitral valve leaflet. As the mass was highly mobile, suggesting a high risk of embolization, he underwent surgical resection. A histopathological examination revealed multiple nodular amorphous calcifications, along with fibrous connective tissue. There were no identifiable myxoma or malignancy cells. Consequently, the diagnosis of calcified amorphous tumor was confirmed.
In the present case, a calcified amorphous tumor arose from mitral annular calcification. A characteristic of mitral annular calcification-related calcified amorphous tumor is its highly mobile nature, with a high risk of stroke or other systemic embolism. Therefore, surgical therapy should be considered for treatment of calcified amorphous tumors.
心脏钙化性非晶性肿瘤是一种罕见的非肿瘤性心脏肿块，其特征是在无定形变性纤维蛋白物质背景下出现结节状钙化。心脏钙化性非晶性肿瘤的临床诊断可能具有挑战性，目前的单一成像技术无法特异性地将其与其他心脏肿瘤，如钙化性心房黏液瘤、钙化血栓或赘生物区分开来。完整的手术切除是改善症状、预防栓塞以及进行病理诊断的首选治疗方法。
一名70岁患有终末期肾病的亚洲男性在运动时主诉胸部不适。他既往无血栓栓塞或心内膜炎病史。经胸超声心动图显示二尖瓣环钙化以及一个高度活动的肿块（8×6毫米）附着于二尖瓣后叶心室侧。由于该肿块高度活动，提示栓塞风险高，因此他接受了手术切除。组织病理学检查显示多个结节状无定形钙化，伴有纤维结缔组织。未发现黏液瘤或恶性细胞。因此，钙化性非晶性肿瘤的诊断得以证实。
在本病例中，钙化性非晶性肿瘤起源于二尖瓣环钙化。二尖瓣环钙化相关的钙化性非晶性肿瘤的一个特点是其高度活动的性质，具有中风或其他全身栓塞的高风险。因此，对于钙化性非晶性肿瘤的治疗应考虑手术治疗。
