PMC6701274_01
Chest CT scan with IV contrast showing a hyperdense mass within the pericardial space, with infiltration into the myocardium, displacing and compressing adjacent structures.
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fig1
In addition to the mediastinal mass, several hyperdense masses were observed in the right lung (Figure 1).
Transthoracic echocardiography. (a) Parasternal short axis view showing tumoral infiltration around the aortic root without obstruction of the outflow tract. (b) Apical 4-chamber view showing myocardial infiltration to the interatrial septum and the free wall of the right atrium and ventricle.
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fig2
Afterward, transthoracic echocardiography was performed, reporting pericardial effusion with the presence of a mediastinal mass that compromised all four cardiac cavities, infiltrating both atria and partially obstructing the right atrium (Figure 2).
(a) Microphotography H&E (20x). In the center, we can observe a blood vessel surrounded by neoplastic cells in two different patterns: cells forming nests and spindle cells fusing with each other. (b) Microphotography H&E (40x). The tumoral cells are shown in detail, with a medium to large size, scant cytoplasm, oval nuclei of vesicular chromatin, prominent nucleolus, and several mitotic figures. (c) Immunochemistry of the CD31 marker: the neoplastic cells' cytoplasm and membrane are positive, while the bronchial epithelium is negative.
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fig3
A biopsy was taken (Figure 3), and, macroscopically, the specimen was a 7 x 4 x 2 cm lung parenchyma, with multiple, well-circumscribed solid brown nodular lesions surrounded by collapsed lung tissue.