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Multifocal “tapete” papillary fibroelastoma
  1. K B Law1,
  2. K R B Phillips1,
  3. R J Cusimano2,3,
  4. J Butany1,2
  1. 1
    Department of Pathology, Toronto General Hospital/University Health Network, Toronto, Ontario, Canada
  2. 2
    Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3
    Division of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
  1. Correspondence to Professor J Butany, Department of Pathology, Toronto General Hospital, 11th floor, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada; jagdish.butany{at}


Papillary fibroelastomas (PFEs) are benign cardiac tumours that typically arise on diseased aortic or mitral valves. Usually solitary, PFEs are characterised by numerous frond-like branches attached to the valve surface by a single stalk, elastic tissue present within the central core, and the appearance of a sea anemone when immersed in water. PFEs have a predilection for men with a mean age of 56 years. A very rare case of a 25-year-old man with multiple lesions on the aortic and mitral valves and a large confluent “carpet-like” lesion in the left ventricular cavity is presented. Admitted with a significant left middle cerebral artery stroke and hemiplegia, investigations showed a left ventricular outflow tract lesion, with surgical excision displaying a multifocal “carpet-like” PFE. Histopathological examination showed various lesions presenting with a short stem, several fronds arising from each stem like a “tree trunk”, and elastic tissue within the central core. This case is presented, along with a review of 833 reported cases of PFEs published after the year 2001. It is believed that this is the first reported instance of surgically resected and morphologically confirmed multiple PFEs seen and removed at one operation.

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; not externally peer reviewed.