PMC10164846_01
Right parasternal short-axis echocardiographic image revealing mild-to-moderate pericardial effusion.. RV = right ventricle; LV = left ventricle; PCE = pericardial effusion
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The following day a brief echocardiogram performed by a board-certified internal medicine specialist confirmed the presence of mild-to-moderate PCE in the absence of left atrial enlargement (left atrial diameter 1.47 cm; RI 1.03-1.71)   or systolic dysfunction, as indicated by normal fractional shortening (68%; RI: 40-66.7) (Figure 1).   A 4 cm mass lesion was noted in the left pericardial space, with differentials including hematoma following pericardiocentesis, infiltrative pericardial disease, granulomatous disease, neoplasia or infectious/inflammatory pericarditis (Figure 2).
Right parasternal short-axis echocardiographic image revealing a mass in the pericardial space; markers indicate a measurement of 0.477 cm in this plane.. LA = left atrium; Ao = aorta; RV = right ventricle
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The following day a brief echocardiogram performed by a board-certified internal medicine specialist confirmed the presence of mild-to-moderate PCE in the absence of left atrial enlargement (left atrial diameter 1.47 cm; RI 1.03-1.71)   or systolic dysfunction, as indicated by normal fractional shortening (68%; RI: 40-66.7) (Figure 1).   A 4 cm mass lesion was noted in the left pericardial space, with differentials including hematoma following pericardiocentesis, infiltrative pericardial disease, granulomatous disease, neoplasia or infectious/inflammatory pericarditis (Figure 2).
(a) Photomicrograph of an impression smear from the nodular epicardial lesion illustrates a population of atypical, round to spindloid mesenchymal cells admixed with brightly eosinophilic matrix. These cells occasionally contain dark-pink cytoplasmic granules. Mild neutrophilic inflammation is present. (b) Photomicrograph of the same preparation illustrates the cytologic detail of the neoplastic population, including anisocytosis, anisokaryosis, binucleation and large, distinct nucleoli. Erythrophagia is present (lower left corner). Wright-Giemsa stain
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An impression smear of the nodular epicardial lesion was submitted for cytologic evaluation while histopathologic evaluation was pending (Figure 3).
Photomicrograph of histopathologic findings from sections of grossly identified pericardial nodules, illustrating highly atypical malignant spindle-to-round cells which, in some areas, become very pleomorphic, demonstrating severe anisocytosis, anisokaryosis and multinucleation
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Histopathologic evaluation of the myocardial and pericardial tissues revealed pleomorphic neoplasia with mild myocardial invasion, with differentials including histiocytic sarcoma, pleomorphic mesothelioma and pleomorphic sarcoma (Figure 4).