Pulmonary blastoma captured by the mitral valve

Excerpt

A 66-year-old male presented to our facility with stomach pain, palpitation, and shortness of breath. Upon examination, tumors in the stomach and lung were revealed, and a biopsy of the stomach tumor confirmed its malignancy. Positron emission tomography (PET) exhibited 18F-fluoro-2-deoxy-D-glucose uptake in both the lung and the stomach (Fig. 1a). Transthoracic echocardiography (TTE) incidentally disclosed a mobile mass on the mitral valve (MV). The mass was detected on the left ventricular side of the anterior mitral leaflet (AML) and had a botryoid appearance (Fig. 1b–d). The mass was highly mobile (Fig. 1c, d) and did not affect any valvular functions or hemodynamics. As the mass posed a substantial risk of embolization, we performed a partial gastrectomy and cardiac surgery following the cancer team’s decision. A left atriotomy revealed neither a thrombus nor a tumor within the pulmonary veins or the left atrium, and only a portion of the tumor could be observed in the chordae of the AML. A subsequent aortotomy revealed a botryoid-like tumor tangled in the chordae of the AML, and we easily removed the tumor (Fig. 1e) as it had not adhered. We then performed a left lower lobectomy approximately 1 month later, and the pathological study confirmed our pulmonary blastoma (PB) diagnosis. Further, the cardiac tumor turned out to be a rare fragmented PB (Fig. 1e, f), and the stomach tumor was diagnosed as the metastatic tumor.

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