Figure Legends:
Figure-1: Transthoracic echocardiography shows an immobile non
homogeneous lobulated mass with a size of 37 x 28 mm ² in the right
ventricle (RV) apex.
Figure-2: Cardiac MRI depicts a round ( 35 x 35 x 31 cubic
millimeters ) intracavitary mass in the RV apex with well-defined
borders and attachment versus infiltration of the RV side of the apical
septal segment and apical wall of the right ventricle. There is no
evidence of pericardial reaction or extracardiac invasion.
A: On steady-state free precession (SSFP) cine images - coronal view,
the mass appears slightly and non-homogeneously hyperintense relative to
normal myocardium (arrowheads).
B: On fast spin-echo T1 weighted-sequence - sagittal view, the mass
appeared homogenous isointense relative to normal myocardium
(arrowheads) as it was in T1 weighted-sequence with fat suppression (not
shown here).
C: On T2 weighted-sequence - axial view, the mass appeared homogeneous
hyperintense relative to normal myocardium (arrowheads) .
D: On STIR sequences - sagittal view, the mass appeared homogeneous
hyperintense relative to normal myocardium (arrowheads).
Figure-3: A: An extensive tumor with the origin of the right
ventricle is evident (arrows).
B: Gross pathology of the resected tumor denotes a whitish brown solid
mass.
Figure-4: Microscopic pathology demonstrates admixture of
vasculatures with irregular, varying size lumina (arrowheads)
interspersed by eosinophilic fibroblasts and collagen depositions
(arrows) in favor of angiofibroma (H & E x 100) (A); Vascular spaces
shows positive CD31 immunoreaction (arrows) which supports the
endothelium presence (CD31 x 400) (B); Desmin immunohistochemical (IHC)
staining indicates reactivity only in the smooths muscles around the
vessels but stroma did not show any reactivity (Desmin x 100) (C); On
trichrome staining, the most of the stroma depicts bluish coloration
which is further supportive of fibrotic tissue (D) whereas, in picture D
window, the myocardial muscle took red-brown color favored the muscle
existence (absent in tumor pathology section) (trichrome x 100). Desmin
IHC and trichrome staining findings confirmed the diagnosis of
Angiofibroma.