A case of mesothelial/monocytic cardiac excrescence causing severe acute cardiopulmonary failure

Department of Pathology, University of California, San Diego, CA 92103-8720, USA.
American Journal of Surgical Pathology (Impact Factor: 5.15). 05/2005; 29(4):564-7. DOI: 10.1097/01.pas.0000155165.78785.8b
Source: PubMed


Mesothelial/monocytic incidental cardiac excrescence (MICE) is a benign lesion composed of a haphazard mixture of mesothelial cells, histiocytes, and fibrin, often found incidentally during cardiac valve replacement. Its pathogenesis is controversial with some authors favoring an artifactually produced amalgam while others espoused a reactive phenomenon. Clinically, this entity is important because of potential misdiagnoses as malignancies. We report a case in a 65-year-old man with severe acute aortic regurgitation. A 2.0-cm mobile aortic valve vegetation was documented by transesophageal echocardiography prior to any cardiac instrumentation. At surgery, the lesion was immediately visualized together with free-floating vegetation in the left ventricular outflow tract. Routine and immunohistochemical examination showed a nodule composed of predominantly histiocytes and mesothelial cells, together with fibrin and scattered neutrophils. To our knowledge, this is the first reported case of a mesothelial/monocytic cardiac excrescence causing acute cardiopulmonary failure. The literature on MICE is reviewed with discussion of its etiology.

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    • "This was supported by many studies reporting a history of prior catheterization in the majority of patients [11]. The artifact theory postulated that MICE are artifactual [12], formed by the manipulation (compaction ), where tissue fragments are collected in suction catheter tips and transferred to the intravascular space during open-heart surgery [9] [10]. Regardless of their exact pathogenesis, cardiac MICE are of potential clinical interest because they may be misdiagnosed as neoplasms or metastatic adenocarcinoma or be associated with severe clinical presentation as acute aortic dissection. "
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    ABSTRACT: Acute aortic dissection is a life-threatening condition mainly caused by hypertension, atherosclerotic disease and other degenerative diseases of the connective tissue of the aortic wall. Mesothelial/monocytic incidental cardiac excrescences (cardiac MICE) is a rare benign reactive tumor-like lesion composed of admixture of histiocytes, mesothelial cells, and inflammatory cells set within a fibrinous meshwork without a vascular network or supporting stroma. Cardiac MICE occurring in association with aortic dissection is exceptionally rare (only one such case reported to date). We herein report on the surgical repair of two Stanford type A aortic dissections caused by idiopathic giant cell aortitis in a 66-year-old-woman and by atherosclerotic disease in a 58-year-old-man, respectively. In both cases, the dissections could be visualized via computed tomography. Histopathology showed cardiac incidental MICE within the external aortic wall near the pericardial surface which was confirmed by immunohistochemistry.
    International journal of clinical and experimental pathology 06/2015; 8(4):3850-3856. · 1.89 Impact Factor
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    • "Through embolization, it may cause myocardial or multiorgan infarctions, in some cases it may be fatal. Although it is known that it is found incidentally, the lesion causing acute cardiopulmonary failure has also been reported [17]. The fact that PCNA positivity was not demonstrated in mesothelial cells supports the nonproliferative and nonneoplastic nature of the lesion [18]. "
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    ABSTRACT: A 58-year-old woman with a history of childhood acute rheumatic fever and resultant mitral valve stenosis was admitted to our cardiovascular surgery clinic complaining of tachycardia, dyspnea, and chest pain. After clinical and radiological findings were evaluated, mitral valve replacement, tricuspid De Vega annuloplasty and plication, and resection of giant left atrium were performed. Atrial thrombus was removed from the top of the left atrial wall. Operation material considered as thrombus was sent to a pathology laboratory for histopathological examination. It was diagnosed with mesothelial/monocytic incidental cardiac lesion (cardiac MICE). Microscopic sections revealed that morphological features of the lesion were different from thrombus. The lesion was composed of a cluster of histiocytoid cells with abundant cytoplasm and oval shaped nuclei and epithelial-like cells resembling mesothelial cells within a fibrin network. Epithelial-like cells formed a papillary configuration in the focal areas. Mitotic figures were absent. Here we present a case which was incidentally found in a patient who underwent mitral valve replacement surgery, as a thrombotic lesion on the left atrium wall.
    03/2013; 2013:836398. DOI:10.1155/2013/836398
  • American Journal of Surgical Pathology 12/2005; 29(11):1545. DOI:10.1097/01.pas.0000180439.64151.a9 · 5.15 Impact Factor
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