PMC2864446_01
Electrocardiogram showing ST segment elevation in leads I, aVL, and V2-V6.
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Electrocardiogram showed 1 mm ST segment elevation in anterior chest leads (Figure 1).
(a) Transesophageal echocardiogram of 4-chamber view showing tumor mass (T) compressing the left atrium (LA). A pericardial effusion (PE) is adjacent to the left ventricular (LV) free wall. RV = right ventricle. (b) Transesophageal echocardiogram of left ventricular (LV) outflow tract in long axis showing homogenous tumor (T) mass with lucent spaces (*) compressing the left atrium (LA). AO = Ascending aorta. RV = right ventricle.
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 Transesophageal echocardiogram showed global LV severe hypokinesis with ejection fraction (EF) of 10 percent and a large mass indenting the left atrium and pulmonary veins (Figures 2(a) and 2(b)).
Computed axial tomogram showing a mass in left anterior mediastinum at the root of pulmonary artery with right anterior pericardial involvement and effusion.
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CT scan, a large superior mediastinal mass extended to the aortopulmonary window and abutted the aortic arch and pulmonary artery (Figure 3). CT guided biopsy revealed thymoma with undifferentiated cells. 
Parasternal long-axis views showing severe baseline LV dysfunction (Figures 4(a) and 4(b)) and improved ejection fraction on the followup study (Figures 4(c) and 4(d)).
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A repeat echocardiogram several days later showed improved LV function with an EF of 45% (Figure 4).
Histopathology demonstrating multinucleated giant cells and numerous lymphocytes infiltrating the cardiomyocytes.
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Histological examination of the myocardium showed large multinucleated epitheliod cells, plasma cells, and lymphocytes characteristic of GCM (Figure 5).