Akabane Kentaro, Kuroda Yoshinori, Uchida Tetsuro
Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, JPN.
Cureus. 2024 Dec 27;16(12):e76486. doi: 10.7759/cureus.76486. eCollection 2024 Dec.
Papillary fibroelastomas (PFEs) are rare, benign, primary cardiac tumors, typically found on the valve surfaces and more commonly on the left side of the heart, with occurrences in the right atrium even rarer. In this case, a highly mobile tumor was incidentally detected in the right atrium of an 83-year-old woman with advanced right lung cancer during preoperative transthoracic echocardiography and magnetic resonance imaging. Although the patient was asymptomatic and of advanced age, the tumor's high mobility warranted resection. Given her low surgical tolerance, simultaneous cardiac and lung surgery was deemed too risky. Therefore, we decided to prioritize right upper lobectomy for lung cancer, followed by minimally invasive cardiac surgery (MICS) for tumor resection. The postoperative course was uneventful, and pathological examination confirmed the diagnosis of a PFE. Although PFEs are benign and often asymptomatic, especially when located on the right side of the heart, they can lead to fatal complications such as acute myocardial infarction or pulmonary embolism. Therefore, early surgical resection should be considered, particularly for highly mobile tumors. In addition, resection via MICS may be an effective option, depending on the location and morphology of the tumor.
乳头状纤维弹性瘤（PFEs）是一种罕见的良性原发性心脏肿瘤，通常发现于瓣膜表面，更常见于心脏左侧，在右心房出现的情况更为罕见。在本病例中，一名83岁患有晚期右肺癌的女性在术前经胸超声心动图和磁共振成像检查时，偶然在右心房发现了一个活动度很高的肿瘤。尽管患者无症状且年事已高，但肿瘤的高活动度仍需进行切除。鉴于她手术耐受性低，同期进行心脏和肺部手术被认为风险太大。因此，我们决定优先进行肺癌的右上叶切除术，随后进行微创心脏手术（MICS）切除肿瘤。术后过程顺利，病理检查确诊为PFEs。尽管PFEs是良性的，通常无症状，尤其是位于心脏右侧时，但它们可导致致命并发症，如急性心肌梗死或肺栓塞。因此，应考虑早期手术切除，特别是对于活动度高的肿瘤。此外，根据肿瘤的位置和形态，通过MICS进行切除可能是一种有效的选择。
