Case-series-report: Two cases of Toothpaste Tumour in elderly women, a longitudinal case investigation

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Caseous calcification of the mitral annulus (CCMA) (n=2). Intervention: Caseous calcification of the mitral annulus (CCMA). Primary outcome: Clinical course and stability of CCMA lesions.

Q: What does this research mean for the field?

In two elderly women with caseous calcification of the mitral annulus, the condition remained stable over six years without significant symptoms or change in lesion size. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jonathan Bennewitz; Oliver Ritter; G. Sachse; Lena Marie Dendl; A. Schreyer

doi:10.1093/ehjcr/ytag075

January 29, 2026European Heart Journal - Case ReportsOpen Access

Case-series-report: Two cases of Toothpaste Tumour in elderly women, a longitudinal case investigation

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Key result

Caseous calcification of the mitral annulus remained stable over six years of follow-up in two elderly women with arterial hypertension and chronic renal failure.

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Why the study?

Caseous calcification of the mitral annulus is a rare variant of mitral annulus calcification whose prognosis and pathogenesis remain obscure.

Key Points

The aim is to investigate the presentation and management of caseous calcification of the mitral annulus in elderly women.
Reported two cases of elderly women with toothpaste tumour (CCMA)
Utilized multimodality imaging including TEE, cardiac CT, and CMRI for diagnosis
Documented clinical findings over six years of follow-up
Patient 1 developed worsening symptoms leading to aortic stenosis and coronary artery disease, ultimately dying from cardiogenic shock
Patient 2 underwent stenting for coronary artery disease, with stable CCMA observed in follow-up imaging
Both cases remained stable over six years, highlighting the benign nature of CCMA despite possible complications.

Study Design

Type

Case Report (n=2)

Structured PICO

P

Population

Two elderly women with caseous calcification of the mitral annulus, arterial hypertension, and chronic renal failure, followed for six years.

E

Exposure

Multimodality imaging (TEE, cardiac CT, CMRI) and conservative management

O

Outcome

Clinical course and stability of CCMA dimensions

Caseous calcification of the mitral annulus (CCMA) can remain stable over several years, supporting conservative management in high-risk patients.

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Answers are grounded in this paper and cite their sources.

Implication

May support conservative management in select asymptomatic elderly patients; leaves open need for prospective data on CCMA progression.

Abstract

Background Caseous calcification of the mitral annulus (CCMA), also referred to as “toothpaste tumour”, is a rare variant of calcification of the mitral annulus (MAC). The prognosis and pathogenesis of CCMA remain obscure. Overall CCMA is benign and usually asymptomatic, but can manifest with abscess formation, embolic events such as stroke or significant mitral valve dysfunction. Case Summary We report two cases of CCMA in elderly female patients. Patient 1 presented with dyspnoea and was diagnosed with CCMA and aortic valve stenosis. When her symptoms worsened over time, severe coronary artery disease was diagnosed in addition. Multimodality imaging, using transoesophageal echocardiography (TEE), cardiac computed tomography (CT) and cardiac magnetic resonance imaging (CMRI) confirmed CCMA that remained stable over the lifetime of the patient. Due to high surgical risks, a conservative management was chosen. Six years later, the patient died from decompensated aortic stenosis with cardiogenic shock. Patient 2 initially presented with chest pain. Three-vessel coronary artery disease was diagnosed and treated with stent implantation by staged percutaneous coronary intervention. Subsequent imaging (TEE, cardio-CT) revealed CCMA. Annual echocardiographic examination showed stable dimensions of the CCMA lesion over six years of follow-up. Discussion Early recognition of CCMA is crucial because it may lead to serious complications. Although spontaneous resolution has been reported, CCMA remained stable over several years in both of our cases. Both patients were elderly women with arterial hypertension and chronic renal failure, supporting the hypothesis of an atheroma-like pathogenesis.

Discussion

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Cite This Study

Bennewitz et al. (2026) conducted a case report in Caseous calcification of the mitral annulus (CCMA) (n=2). Caseous calcification of the mitral annulus (CCMA) was evaluated on Clinical course and stability of CCMA lesions. Caseous calcification of the mitral annulus remained stable over six years of follow-up in two elderly women with arterial hypertension and chronic renal failure.

synapsesocial.com/papers/6981020cc1c9540dea8133b4 https://doi.org/10.1093/ehjcr/ytag075

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Case-series-report: Two cases of Toothpaste Tumour in elderly women, a longitudinal case investigation

Figures

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Case-series-report: Two cases of Toothpaste Tumour in elderly women, a longitudinal case investigation

Figures

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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