A Rare Pericardial Malignancy

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A Rare Pericardial Malignancy by Urooj Fatima, Sarika Gupta, Dennis J. Firchau, Alan H. Stolpen, and Rajan Sah Circ Heart Fail Volume 9(7):e003282 July 13, 2016 Copyright © American Heart Association, Inc. All rights reserved.

Computed tomography (CT) and cardiac magnetic resonance imaging (MRI) of pericardial mesothelioma. Computed tomography (CT) and cardiac magnetic resonance imaging (MRI) of pericardial mesothelioma. Coronal (A) and sagittal (B) reformatted images from contrast-enhanced CT. Still frames from noncontrast 4-chamber (C) and contrast-enhanced 2-chamber (D) bright blood cine gradient echo MRI and contrast-enhanced axial T1-weighted MRI (E and F). Images show thick, lobulated enhancing soft tissue (white arrows) encasing the great vessels (A, B, and E) and heart (B–F). The pericardial tumor thins and focally interrupts the epicardial fat (black arrowheads, C and F). Urooj Fatima et al. Circ Heart Fail. 2016;9:e003282 Copyright © American Heart Association, Inc. All rights reserved.

Gross findings at autopsy. Gross findings at autopsy. Photographs taken at autopsy of the intact lung and heart (A), heart (B and C), and heart cross-section (D). The right lung showed fibrous adhesions with the pericardium (A, arrow). Intact heart (B and C) shows tumor completely encasing the heart and great vessels. Cross-section of the heart (D) illustrates tan-white solid tumor encasing the heart with infiltration into the pericardium (black arrows), epicardial fat (white arrows), and partial thickness ventricular myocardium (arrow heads). Urooj Fatima et al. Circ Heart Fail. 2016;9:e003282 Copyright © American Heart Association, Inc. All rights reserved.

Histopathology and immunohistochemistry. Histopathology and immunohistochemistry. A–D, Staining of tissue specimen obtained from surgical biopsy (VATS). E-G, Staining of tissue obtained from autopsy. A, Tumor cells staining for CK7 (50×). B, Mild focal staining with calretinin (100×). C, Staining with desmin (50×). D, AE1/AE3 staining (50×). E, Light microscopic image of the tumor stained with hematoxylin and eosin (20×), illustrating biphasic tumor composed of tubulo-papillary elements and cords of epithelial cells, with prominent nuclei (E, 200×, arrows in inset), mixed with closely packed spindle cells (E, 200×, arrowheads). F, Immunohistochemical staining with pankeratin (20×), with strong diffuse staining of the epithelioid areas (arrows). There is patchy, moderate to weak staining of pankeratin in the sarcomatoid areas (arrowheads). G, Staining with Wilm’s Tumor-1 (WT-1) reveals weak, focal staining of epithelioid areas (arrows) with patchy, moderate to weak staining of the sarcomatoid areas (arrowheads; 20×, inset 200×). VATS indicates video-assisted thoracoscopic surgery. Urooj Fatima et al. Circ Heart Fail. 2016;9:e003282 Copyright © American Heart Association, Inc. All rights reserved.