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Cardiac papillary fibroelastoma is reported to be the 2nd most common cardiac tumor following myxoma. Owing to the risk of embolism, early surgical excision is the treatment of choice. We report a case of effective anticoagulation therapy prior to surgical excision of an aortic valve papillary fibroelastoma. A 78-year-old man was admitted to our hospital because of transient cerebral ischemic attack. The symptom was relieved in a short period. Echocardiography revealed a tumor at the aortic valve. Cardiac computed tomography revealed a sea-anemone-like appearance of the tumor. Cardiac papillary fibroelastoma was suspected on close examination. The operation was postponed because of gingivitis that required draining. During 3 months awaiting the operation, he continued receiving anticoagulation therapy, which successfully prevented thromboembolism. Administration of anticoagulation therapy may be considered, unless early surgical excision can be performed.

A 73-year-old woman with cardiac tumor arising from aortic valve was scheduled for extirpation surgery. She has a symptom of chest discomfort during her walk. Contrasted CT scan around the aortic valve demonstrated a 1 cm-size tumor close to the left coronary inlet. Coronary blood flow was preserved. On the day of admission she became unconscious during preoperative interview with the surgeon. Cardiopulmonary resuscitation was immediately initiated and she regained her consciousness. Emergency operation was scheduled and started about two hours after the event of syncope. Cardiac tumor attached to the left cusp of the aortic valve was found and later identified as papillary fibroelastoma by pathological diagnosis. She was discharged on the 13th day from admission without neurological deficit. Occlusion of the left coronary artery inlet was strongly suspected from preoperative event of her syncope. Cardiac tumor around aortic value may cause significant derangement of circulation, and we should closely monitor the patient's status and prompt operation was indicated especially when tumor is impeding coronary artery inlet.

We report a case of papillary fibroelastoma of the aortic valve. A 72-year-old man was referred to our hospital with cardiac tumor incidentally detected by transthoracic echocardiography. Transesophageal echocardiography showed a mobile tumor on the ventricular side of the aortic valve. We performed semi-emergency surgery and resected the tumor with a blade to prevent embolism. Pathologic findings revealed papillary fibroelastoma. The postoperative course was uneventful, and the patient was discharged 10 days arter surgery. Follow-up transthoracic echocardiography has not shown any evidence of local recurrence.

In 1982, a 63-year-old woman underwent open mitral commissurotomy for rheumatic mitral stenosis. She was referred to our hospital for surgical treatment of mitral restenosis in 2003. Preoperative echocardiography showed rheumatic mitral valve restenosis and demonstrated a mobile mass of the aortic valve. During the operation, a mitral valve replacement was performed using prosthetic valve (SJM 29 mm) and a tricuspid valve was repaired by annuroplasty (De Vega). Through the aortotomy, a multiple frond-like tumor, measuring 5 mm, was found attached to the free-edge of the left-coronary cusp of the aortic valve. The resection of the tumor was performed without valve replacement. The histopathologic diagnosis was papillary fibroelastoma. The postoperative course was uneventful. In the pathogenesis of this case, the iatrogenic factor may have played a role in tumor development.

Papillary fibroelastoma is a rare cardiac tumor. We report a case of surgical treatment for aortic valve papillary fibroelastoma. The patient was a 64-year-old female. She admitted our hospital for the evaluation of cardiogenic cerebral infarction. The echocardiogram revealed a mobile rounded mass (10 x 6 mm) of the aortic valve and aortic regurgitation. On the basis of these echo findings, we performed operation. Under cardiopulmonary bypass, aortotomy was made and aortic valve was observed. A tumor was on the non-coronary-cusp of the aortic valve, which was successfully removed followed by aortic valve replacement with 21 A Carpentier-Edwards bio-prosthetic valve. The tumor was histologically diagnosed papillary fibroelastoma. Following uncomplicated postoperative course, the patient was discharged on twenty-first postoperative day.

A 39-year-old man presented with acute onset of left arm and left side face weakness, and mild expressive aphasia. He was referred for two-dimensional echocardiography, which demonstrated a 13 mm diameter pedunculated, mobile, echodense mass attached to the anterior leaflet of the mitral valve. At operation, the tumor was a 10 x 10 x 15 mm, rounded, and yellow-whitish mass with a short stalk arising from rough zone of the anterior leaflet of the mitral valve. The surface appeared to be sean anemone. The mitral valve with this tumor was excised and replaced with a 29 mm St Jude Medical mechanical valve. The pathological findings are typical of a papillary fibroelastoma.

The authors describe a case of xanthofibroma of the skull. A 53-year-old female was admitted to our hospital in September, 1991, with subarachnoid hemorrhage due to a ruptured aneurysm of the anterior communicating artery. The roentgenogram of her skull incidentally revealed the presence of a radiolucent (a punched out) lesion of about 20 x 25 mm in the right occipital bone. On computed tomography (CT), the mass was seen to be mainly localized in the diploe, and the outer table of the skull was thinned. On both T1 and T2 weighted magnetic resonance image (MRI), the mass showed a high intensity signal equivalent to that found in adipose tissue. The bony tumor was totally removed. Histology revealed a collection of foamy cells, benign fibrous tissues and so on which led to a diagnosis of xanthofibroma of the skull without hyperlipidemia. Xanthofibroma of the skull is extremely rare. To our knowledge, including our case, only three cases have been reported.

A 48-year-old woman with negative T waves in leads I, a VL and V4-6 in the ECG was examined. The cross-sectional echography and the MRI revealed that she had a tumor in the free wall of the left ventricle. Under the cardiopulmonary bypass, the intramural fibroma (6 by 6 by 4 cm) of the left ventricle was resected and the defect was repaired by sutures of the outer myocardial layers to keep the left ventricular volume. Forty eight days after the initial operation, a reoperation was performed by interrupted sutures of the whole myocardial layers. She is doing well without any troubles 14 months after the reoperation.

As desmoid tumors invade locally and postoperative recurrence is common, accurate diagnosis of the extent of the tumor is needed prior to surgery. CT and/or MRI evaluation of tumor extension was retrospectively studied in eight patients with desmoid tumors, and the results were correlated with the histopathological findings. All tumors were completely resected even in patients who were evaluated by CT alone. However, the delineation of tumor and local invasion were not clearly demonstrated by CT. On the other hand, the delineation of tumor and local invasion were well visualized on MRI. The MRI picture of desmoid tumors was mainly composed of two different areas of signal intensity. The area of hypointensity in both T 1- and T 2-weighted images was found to have abundant collagen fibers, while the area of isointensity or slight hyperintensity in T 1-weighted images and hyperintensity in T 2-weighted images was found to have fibroblasts. In conclusion, MRI is better suited to the evaluation of patients with desmoid tumors than CT.

We report a case of pelvic fibromatosis, which has been rarely found. A 36-year-old man referred to our hospital complaining of right abdominal pain and a swelling mass. Abdominal CT and transabdominal echogram revealed a tumor contacted to the bladder. A nonpapillary tumor (little finger sized) at the bladder dome was observed by cystoscopy, and the tumor was clinically considered as urachal tumor. Wide radical excision including the bladder and prostate was performed. Pathological diagnosis was pelvic fibromatosis arising from musculoaponeurotic structures in the pelvis: The fibromatosis is benign nonmetastatic tumor but the recurrence rate is considerably high. However, in the present case, 14 months after operation there is no recurrence yet.

A case of desmoid tumor of the abdominal wall which was preoperatively suspected as urachal tumor is presented. The patient was a 56-year-old man, who was referred to our clinic for further examination of the mass detected incidentally in the ventral region of the urinary bladder by computed tomography. Ultrasonography showed that the mass had a heterogenous and hypoechogenic content. An urachal tumor was suspected and surgery was performed to remove the tumor. During the operation we found that the tumor was completely separated from the urinary bladder and that it had originated from the left rectus abdominal muscle. The pathological diagnosis was desmoid tumor of the abdominal wall. Since urachal tumor has no characteristic findings on the imaging examinations, it is difficult to differentiate desmoid tumor of the lower abdominal wall from urachal tumor, preoperatively.

Ossifying fibroma is relatively common in the maxilla, but rare in the cranial vault. A 10-year-old girl was referred for painful swelling of the left temporal region. On admission, she presented no abnormal physical and neurological findings except for the painful swelling. Plain skull X-ray films showed a radiolucent lesion of the left temporal bone about 4 cm in diameter, with a hyperostotic area of the parietal side. Computed tomography scan using bone window level also showed an abnormal density lesion in the same site. Curettage of this tumor was performed from a cosmetic point of view and at the family's petition. Histological examination showed vascular fibrous tissue in which lamellar bone was surrounded by osteoblasts.

Gd-DTPA (Gd) has been shown to provide effective contrast enhancement in MR imaging. However, it is sometimes impossible to evaluate Gd contrast enhancement (C.E.) in high intensity tissues like fat and bone marrow. To solve this problem, color-hybrid images (hybrid images) were generated by the use of an RGB mixing method. A total of 54 lesions, including 30 bone and soft tissue lesions and 24 gynecological lesions, were studied. In most cases, the hybrid images were superior to the original ones in terms of both morphologic and temporal evaluation of Gd C.E. The hybrid images helped to define the localization and extent C.E., by providing better visualization through the use of color display.

The frequency of a fibrosarcoma, based on current criteria, is less than 10% of soft tissue sarcomas. It is most common in the region of extremities and the trunk and relatively rare in the head and neck region. Therefore, of interest is a case of a well differentiated fibrosarcoma arising in left neck region of a 69-year-old woman that is reported. The excised tumor consisted of a firm, partially lobulated mass with a fibrous capsule that measured 8 cm at its greatest diameter. Histologically, the tumor tissue was rather uniform and often had a fasciculated growth pattern consisting of spindle shaped cells and interwoven collagenous fiber in a parallel fashion. To achieve a diagnosis, it was necessary to differentiate this type of fibrosarcoma from aggressive fibromatosis and myogenic tumor (leiomyoma or leiomyosarcoma).

A 51-year-old woman manifested with complaints of an abdominal mass 5 years after colectomy. In comparison with the cases previously reported, this desmoid had lower CT value (20-30 HU), and more vascularity with neovascularization on angiography. These findings seem to reflect the characteristic of much cellularity and malignancy of the desmoid.

A 68-year-old female was admitted with mild headache in the right frontal region. Physical and neurological findings were normal. Plain X-rays revealed a poorly circumscribed, osteoblastic lesion in the right frontal bone. Computed tomography scan showed that the diploic space was destroyed but that the inner and outer tables were intact. On 99mTc bone scan, a hot lesion was visible in the same region. The lesion was expressed as a low-signal intensity area on T1-weighted magnetic resonance (MR) image and as a high-signal intensity area on T2-weighted MR image. The tumor was broadly resected together with peripheral normal bone, and cranioplasty using a resin plate was performed. The tumor was mainly composed of mature, regularly aligned bone (lamellar bone) and intermingled fibrous tissue. Ossifying fibroma is a rare, benign fibro-osseous tumor that mainly involves the craniofacial bone. A few cases involving the cranial vault alone have been reported. The relevant literature is reviewed, and discussion focuses on the differential diagnosis between ossifying fibroma and monostotic fibrous dysplasia.

Nine cases of pathologically confirmed orbital tumors were evaluated with magnetic resonance imaging (MRI) at 0.5T. Seven cases were examined with orbit-coil using 7-mm-thick sections and two cases were examined with head-coil using 10-mm-thick sections. All lesions were clearly demonstrated on T1-weighted images as low intensity. However, the lesions were indistinct on T2-weighted images because of low contrast between the lesions and surrounding orbital fat and artefact produced by eye movement. Two of three cases with meningioma examined with orbit-coil were clearly discriminated from the optic nerve. Meningioma in the remaining case examined with head-coil was discriminated from the optic nerve by administration of Gd-DTPA. Adenoma of the right lacrimal gland was shown as an enlarged gland on T1-weighted images. Pseudotumors (four cases) showed very low intensity on T1-weighted images. Three cases of four pseudotumors showed low intensity on T2-weighted images. Among them one was moderately low intensity, and histological examination of the lesion showed prominent fibrotic changes. Pseudotumor of the remaining case examined with the head-coil showed same intensity with fat on T2-weighted images. Intraorbital infiltrating foci of chronic lymphocytic leukemia showed low intensity with fat on T1-weighted images, and the same intensity with fat on T2-weighted images. MRI may be useful to discriminate pseudotumor with fibrotic changes (chronic inflammatory lesions) from lymphoma or leukemic infiltration.

Benign tumors of the kidney were rare entities in the incidence. But, recently, the cases with benign tumors of the kidney which were discovered incidentally have increased by popularization of ultrasonography and computed tomography. It is easy to distinguish a mass on clinical examination, but it is difficult to differentiate definitely either benign tumor or malignant one clinically. Besides, it has been pointed out that cases of renal oncocytoma had fairly been included among the nephrectomized cases because of the diagnosis as renal cell carcinoma. Consequently, we need sufficient knowledge about benign tumors of the kidney. Author discussed an outline of the representative benign tumors of the kidney.

A case of ossifying fibroma of the cranial vault is described. Several reports emphasized the rare existence of this lesion limiting in the cranial vault. The patient was a 76-year-old woman who suffered mild headache in the parietal region after a trivial head trauma. Physical and neurological examination were normal. Plain skull X-P revealed irregularly bordered, 4 X 4 cm sized radiolucent area in the left temporal bone. The bone scintigraphy using 99mTc-MDP showed an abnormal uptake like a doughnut. Levels of serum P, Ca and alkaline phosphatase were within normal range. A tumor was softer than normal skull, and undertaken piecemeal removal. The dura was normal. After the total removal of the tumor, cranioplasty using Resin plate was performed. Microscopically the lesion was composed immature, irregular spicules of bone and fibrous tissue. Abundant fibroblasts were arranged in a random fashion in the stroma. Characteristically, the spicules of bone surrounded by rimming of osteoblasts. Ossifying fibroma is a benign fibroosseous tumor. Although this tumor is typically found in the maxillary sinus and mandible, it has also been reported in the paranasal sinuses, frontal, ethmoid, sphenoid bone and orbital roof of the young adult. But previously reported cases involving the cranial vault alone were only 7 cases. Etiology of ossifying fibroma is almost unknown.