Pathogenesis of Cardiac Valvular Hemangiomas: A Case Report and Literature Review

Figures

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  Figure 1. Preoperative transthoracic echocardiography, four-chamber view; the continuous arrow indicates a mass located on the tricuspid valve, which was diagnosed as an arteriovenous hemangioma; the dotted arrow shows a ventricular septal defect that was resolved surgically.

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  Figure 2. Histological features of the tricuspid valve hemangioma, emphasized with hematoxylin–eosin (HE). Large vascular spaces (A,B; black arrows) and smaller vessels (C,D; red arrows) containing red blood cells and surrounded by connective tissue can be observed; hemosiderin-containing macrophages, along with a mild inflammatory infiltrate, can be seen in the surrounding stroma (E,F; green arrows).

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  Figure 3. Immunohistochemical profile confirming the diagnosis of arteriovenous hemangioma. Positivity for CD31 (A; black arrows) and CD34 (B; black arrows) is specific to endothelial cells lining the vascular channels; paradoxically, endothelial cells stain positive for SMA, a mesenchymal cell marker (C; red arrows); podoplanin D2-40, negative in our case (D), is used to demonstrate the presence of lymphatic endothelium.

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  Figure 4. An input of six genes in the miRNet search engine revealed numerous interactions between them and various transcription factors and microRNAs. In total, 845 microRNAs and 113 transcription factors (TF) have resulted following this search, adding to a total of 1721 edges.

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  Figure 5. The major molecular pathways involved in EndMT, depicting the main genes involved; genes communicate through a complex network of micro-RNAs and transcription factors to transmit signals which influence EndMT. This pattern, showing the interactions between genes (yellow) and transcription factors (blue), was generated using the miRNet platform that collects information from different databases (miRTarBase v8.0, TarBase v8.0 and miRecords).

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  Figure 6. The microRNAs regulating the genes involved in both cardiovascular development and EndMT induction represented in a network created with the help of the miRNet platform, which gathers information from various databases. Four microRNAs of note (yellow) and the genes (green) that they regulate are depicted in this figure.