Incidental Pulmonary Valve Mass: Trick or Treat?

A 73-year-old male with a prior medical history notable for hypertension, type 2 diabetes mellitus, dyslipidemia, and coronary artery disease presents for a consultative opinion regarding a pulmonic valve mass identified on the referring facility's transthoracic echocardiogram (Video 1). He denies any recent angina symptoms, significant dyspnea, orthopnea, fevers, or chills. He is still able to lead a very active lifestyle. Prior testing includes both an echocardiogram and nuclear perfusion study. He has no history of malignancy and is up-to-date on cancer screening exams. His physical examination is unremarkable. He has a normal complete blood cell count and basic chemistry profile. His electrocardiogram is notable for sinus bradycardia but is otherwise unremarkable. Review of the outside echocardiogram reveals that the mass measures approximately 6-8 mm and is on the outflow tract side of the valve. There is mild pulmonic regurgitation.

Video 1

Which of the following describes the most likely diagnosis?

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