Overview
Mesothelial/monocytic incidental cardiac excrescence (MICE) is a benign lesion composed of mesothelial cells, histiocytes, and fibrin, often discovered incidentally during cardiac surgeries or procedures. It can mimic malignancies, particularly metastatic carcinoma, necessitating careful differentiation 1.Diagnosis
Clinical Presentation: Usually asymptomatic, discovered incidentally with pericardial effusion or small cardiac masses 1.
Imaging: Echocardiography and CT scans may reveal pericardial masses or effusions 1.
Histopathology: Definitive diagnosis through biopsy showing characteristic cuboidal mesothelial cells, histiocytes, and fibrin deposition 1.
Differential Diagnosis: Metastatic carcinoma, mesothelioma, and other inflammatory conditions 1.Management
Surgical Excision: Recommended for definitive diagnosis and to rule out malignancy 1.
Observation: Asymptomatic cases may be managed with close monitoring without intervention 1.
Further Workup: Consider additional imaging or biopsies if malignancy cannot be excluded clinically 1.Special Populations
Elderly: No specific considerations noted beyond general management principles 1.Key Recommendations
Perform histopathological examination for definitive diagnosis of MICE to avoid misdiagnosis as malignancy (Evidence: Moderate 1).
Asymptomatic patients with incidental MICE findings may be managed with observation rather than immediate surgical intervention (Evidence: Expert opinion 1).
Exclude malignancy through comprehensive clinical evaluation and imaging before concluding a benign MICE diagnosis (Evidence: Moderate 1).References
1 Censi S, Dell'Amore A, Conti R, Lorenzini P. Cardiac mesothelial/monocytic-incidental-excrescence: more than an artifactual lesion?. Interactive cardiovascular and thoracic surgery 2008. link