Fibrolipoma of the left ventricle: an uncommon incidental autopsy finding

Our plain-English summary of Fibrolipoma of the left ventricle: an uncommon incidental autopsy finding, by K. Fragkouli, A. Mitselou, T. Vougiouklakis (Forensic Science, Medicine, and Pathology, 2020).

The study

• Authors: K. Fragkouli, A. Mitselou, T. Vougiouklakis
• Journal: Forensic Science, Medicine, and Pathology
• Published: 2020;16(2):362-365
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

Fibrolipoma of the heart is an unusual benign tumorous entity encountered, if present, during an ordinary imaging workout or at autopsy. It is often clinically silent but it can also be symptomatic depending on the size and location of the tumor. We report a case of an 82-year-old man with a medical history of malignant pleural mesothelioma. The decedent was referred to our department to undergo a forensic autopsy after a fall. Postmortem examination revealed a large encapsulated gelatinous, yellowish cardiac mass with its pedicle on the subendocardial region of the left ventricular anterior wall and interventricular septum, protruding into the left ventricular cavity. Histological examination confirmed the diagnosis of cardiac fibro-lipoma, a rare histologic variant of lipoma, irrelevant to the cause of death in the present case. The rarity of the occurrence of fibro-lipomas provides clinical implications for the inclusion of the entity in the differential diagnosis of a cardiac mass.

In plain English

This article was a case report from the Department of Forensic Medicine and Toxicology at the University of Ioannina, Greece. It described the forensic autopsy of an 82-year-old man who had a known history of pleural mesothelioma and was autopsied after a fall with a scalp injury. The article does not mention asbestos or any exposure history. At autopsy, a mass on the right pleura was confirmed under the microscope as desmoplastic malignant pleural mesothelioma. The heart weighed 710 g and had narrowed coronary arteries. Inside the left ventricle was a 7.0 by 5.5 by 4.0 cm tumor that was identified under the microscope as a cardiac fibro-lipoma, a rare variant of a benign fatty tumor. The cause of death was a fresh heart attack (myocardial infarction) in the back wall of the left ventricle, not the tumor or the mesothelioma. In their department's autopsy records, the authors counted 7 primary heart tumors among 5100 autopsies. The authors concluded that fibro-lipoma of the left ventricle is rare and should be considered when a heart mass is found in adults.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (single forensic autopsy), published as an 'Images in Forensics' article
• Who was studied: One 82-year-old man with a known history of pleural mesothelioma, autopsied after a fall at the Department of Forensic Medicine and Toxicology, University of Ioannina, Greece
• Exposure: No asbestos or other exposure was studied or described. The man's history of pleural mesothelioma is reported, but its cause is not discussed.
• Main results:
  • A diffuse yellowish necrotic mass (8.5 × 7.0 × 3.5 cm) occupied the man's right parietal pleura, extended to the visceral pleura and enclosed the lower lobe of the right lung. Under the microscope it was confirmed as desmoplastic malignant pleural mesothelioma.
  • The heart weighed 710 g and showed significant stenosing atherosclerosis in all major coronary arteries
  • A well-circumscribed, oval, tan yellow mass measuring 7.0 × 5.5 × 4.0 cm was found in the left ventricle. It arose from the endocardium of the interventricular septum and the anterior wall, and extended to the apex of the heart.
  • Under the microscope, the tumor consisted of mature fat cells within a fibrous network of dense collagen. This appearance was consistent with cardiac fibro-lipoma.
  • The cause of death was a fresh myocardial infarction of the posterior left ventricular wall, confirmed by histological examination. The authors described the fibro-lipoma as an incidental finding that was not considered symptomatic.
  • In the department's autopsy series over a 20-year period, the authors reported 7 primary cardiac tumors found incidentally among 5100 autopsies: 2 atrial myxomas, 1 atrial lipoma, 1 ventricular fibroma, 2 cases of lipomatous hypertrophy of the atrial septum, and 1 ventricular fibro-lipoma.
• The authors' conclusion: The authors concluded that fibro-lipoma of the left ventricle is a rare occurrence and should be included in the differential diagnosis of a cardiac mass in adults.

Topics

Medical terms in this study, explained in our Lexicon: Autopsy, Pleural Mesothelioma, Differential Diagnosis.

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