PMC5140867_01
A: Chest radiography demonstrated an enlarged heart shadow and bilateral pleural effusion. B: Chest computed tomography revealed pericardial and pleural effusion. C: An echocardiographic examination revealed significant pericardial effusion with right ventricular diastolic collapse. D: Cytological findings of pericardial effusion showed a small amount of atypical cells suggestive of malignancy.
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Chest radiography revealed an enlargement of the cardiac silhouette and bilateral pleural effusion (Fig. 1A). Computed tomography (CT) demonstrated pericardial and bilateral pleural effusion without any tumorous lesions on the pleura or pericardium, or in the lung (Fig. 1B). Emergency pericardiocentesis was performed under echocardiographic guidance to achieve an improvement of his circulatory dynamics, and bloody pericardial effusion was drained (Fig. 1C). Although a cytological examination revealed a tiny amount of atypical cells suggestive of malignancy, the information obtained was inadequate to make a definitive diagnosis (Fig. 1D).
A, B: Macroscopically, there is thickening of the pericardium and no nodular lesion of the parietal or visceral pericardium or pleura. C, D: Histologically, the resected pericardium specimen revealed spindle-shaped atypical cells with nucleoli among the infiltrating lymphocytes. E, F: Atypical cells were diffusely positive for CAM5.2 and WT1.
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Macroscopically, the parietal pericardium had become diffusely thickened measuring approximately 8 mm in thickness, while the visceral pericardium showed a thickness of approximately 5 mm (Fig. 2A and B). A histological examination of the resected pericardium specimen revealed spindle-shaped atypical cells with nucleoli among infiltrating lymphocytes (Fig. 2C and D). Immunohistochemistry showed the atypical cells to be diffusely positive for CAM5.2 and WT1, focally positive for calretinin, and negative for TTF-1 (Fig. 2E and F).
A, B: Chest radiography and computed tomography demonstrated pleural tumors in the left thoracic cavity at 21 months after the onset of cardiac tamponade. C, D: Histological findings demonstrated the presence of malignant spindle-shaped cells.
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However, multiple pleural tumors which were absent at least before three months emerged in the left thoracic cavity in November 2011 (Fig. 3A and B). CT-guided biopsy of the pleural tumor was performed, and a histological examination demonstrated malignant cells in the form of spindle-shaped cells showing similar features to the tissue obtained by pericardium biopsy at the onset of cardiac tamponade (Fig. 3C and D).