Abstract：
Mesothelial/monocytic incidental cardiac excrescence (MICE) is a rare benign lesion composed of monocytes and mesothelial cells that is most often encountered during cardiothoracic surgery. We describe a case in a 71-year-old man with known aortic valve stenosis who presented with gradual onset dyspnea over a few weeks, made worse with minimal exertion. A transesophageal echocardiogram revealed severe aortic stenosis and mild pericardial effusion. The patient underwent aortic valve replacement, coronary artery bypass, and amputation of the left atrial appendage. Histological examination of a 0.8 cm blood clot received along with the atrial appendage showed an aggregation of bland cells with features of monocytes associated with small strands and nodules of mesothelial cells, fat cells, fibrin and a minute fragment of bone. Immunohistochemical analysis showed that the monocytic cells were positive for CD4 and CD68 (strong) and negative for calretinin and keratin. By contrast, the mesothelial cells were positive for calretinin and keratin and negative for all other markers. In sum, the morphologic and immunohistochemical findings support the diagnosis of MICE. Based on our review of the literature, about 60 cases of MICE have been reported previously which we have tabulated. We also discuss the differential diagnosis.
摘要：
间皮/单核细胞偶发性心脏病（MICE）是一种罕见的良性病变，由单核细胞和间皮细胞组成，在心胸手术中最常遇到。我们描述了一个71岁的男性，已知主动脉瓣狭窄，在几周内出现逐渐发作的呼吸困难，以最小的努力变得更糟。经食管超声心动图显示严重的主动脉瓣狭窄和轻度心包积液。患者接受了主动脉瓣置换术,冠状动脉搭桥术,左心耳截肢.与心房附件一起接受的0.8厘米血凝块的组织学检查显示，温和的细胞聚集，单核细胞的特征与小股和间皮细胞结节相关，脂肪细胞,纤维蛋白和骨头的微小碎片。免疫组织化学分析显示，单核细胞CD4和CD68（强）阳性，钙视网膜素和角蛋白阴性。相比之下,间皮细胞钙调蛋白和角蛋白阳性,其他标志物均阴性.总之,形态学和免疫组织化学结果支持MICE的诊断。根据我们对文献的回顾，以前报告了大约60例MICE病例，我们已经列出了这些病例。我们还讨论了鉴别诊断。
