A 72 year old man was operated on for a severely stenotic (gradient 120 mm Hg) congenitally bicuspid aortic valve. The valve was replaced by a prosthetic valve and the resected leaflets were stored in formalin for routine pathologic analysis. Under formalin two beautiful sea anemone-like glistening white papillary tumours unfolded at the valvar surface, with all the features of papillary fibroelastomas (panels B and C). The tumours measured 5 mm and 9 mm, respectively.

When the valve leaflets were taken out of the formalin container, the fibroelastomas collapsed like sea anemones do at low tide (panel A, arrow); an image which corresponded with the aspect of the valves at the time of surgery.

(A) Overview of resected valve tissue. Photo is of a “dry specimen”. Arrow indicates collapsed fibroelastomas. (B) Detail of leaflet with unfolded fibroelastomas. Photo is of a wet specimen (placed in water). (C) Histology of fibroelastoma showing cell-poor, elastin-rich (black) papillary structures (elastic van Gieson stain ×24).