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.