Papillary fibroelastoma is a small papillary lesion with sea-anemone-like gross appearance that is usually found on the surface of the cardiac valves or other endocardial surfaces. It is not certain whether they are true neoplasms or reactive lesions. They are usually discovered incidentally at autopsy, cardiac surgery, or on high-resolution imaging studies. Microscopically, it is composed of numerous branching papillary fronds arising from a common stalk. The individual fronds are composed of an avascular core of hyalinized hypocellular stroma with elastic fibers. The fronds are lined by one or more layers of endocardial cells. Image courtesy of: Ankur Sangoi, MD; @slusagar; used with permission.