What forms a tumor-like mass on the valve annulus composed of caseous, putty-like substance?

• A. Caseous annular calcification
• B. Calcified atheroma
• C. Myxoma
• D. Papillary fibroelastoma

Answer: (A)

This is caseous annular calcification, a rare variant of mitral annulus calcification where the center of the calcified ring undergoes liquefactive change, forming a putty‑like, caseous material that creates a tumor‑like mass on the valve annulus. It often sits on the mitral annulus and can mimic a tumor or vegetation on imaging, yet it is a non-neoplastic degenerative process.

The other entities are different: a calcified atheroma is an atherosclerotic plaque in arteries rather than a mass on the valve ring; a myxoma is a true cardiac tumor usually arising in the left atrium and has a gelatinous texture; a papillary fibroelastoma is a small, mobile tumor on valve surfaces, typically not described as containing caseous material.