Papilliferous tumours of the heart valves.

After the first year of life the valves of the human heart become covered by filiform tags, known as Lambl's excrescences. These have been shown by Magarey (1949) to be the result of the organization of partially attached deposits of fibrin on the surface of the valve, and hence may be regarded as a normal ageing process. Lambl's excrescences rarely exceed 1 cm. in length and produce no pathological sequele. Exceptionally, much larger polyps occur on the cardiac valves in the form of papilliferous tumours. Even these usually occur in otherwise normal hearts and rarely give rise to symptoms. Bohrod (1929) for instance described them as "small, harmless bodies". However, the present report of two further examples of such papilliferous tumours of the heart valves shows that, if they arise near the origin of a coronary artery, they may cause symptoms. Case 1. A man, aged 57 years, died from generalized peritonitis following a total gastrectomy for an adenocarcinoma of the stomach. At autopsy the heart weighed 310 g. The cardiac chambers were normal in size. The thickness of the right ventricle was 3 mm. and that of the left ventricle was 13 mm. The tricuspid, mitral, and aortic valves were normal in structure. Two of the three cusps of the pulmonary valve were partially fused. There was no evidence of previous bacterial endocarditis and the fusion appeared to be congenital in nature. On the ventricular surface of the normal cusp was a soft, papilliferous polyp, 5 mm. in diameter. There was only one coronary artery; this originated from the left coronary sinus. On histological examination the polyp had a papillary structure (Fig. 1). The villi were covered with flattened endothelium-like cells (Fig. 2). The core of each villus was composed of hyaline fibrous tissue in which few cells and no blood vessels could be seen (Fig. 2). Between this fibrous core and the lining enidothelium there was a layer of fibrillar myxomatous tissue which was basophilic on staining with heematoxylin and eosin (Fig. 2). Rounded cells, resembling macrophages, with eccentric nuclei and vacuolated cytoplasm were found in this loose tissue. The mucinous material of the myxomatous zone and the macrophages stained feebly with the periodic acid-Schiff reagents, indicating the presence of carbohydrate. This substance proved to be a mucin, as it gave a positive reaction with Southgate's mucicarmine. More precisely it appeared to consist of acid mucopolysaccharide, for it stained strongly with Hale's dialysed iron, the strength of the reaction overshadowing the lack of specificity generally associated with it. Metachromasia was demonstrated with toluidine blue. Small irregular clumped masses of tissue staining positively with Verhoeff's stain for elastic tissue were seen in the pedicle, but not in the tumour villi. Iron pigment was absent.