PMC6755280_01
Computer tomography demonstrated (a) a pericardial effusion and (b) a pleural effusion.
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A pericardial effusion with a maximum hem width at the tip of the heart of 1.9 cm was also observed (Figure 1).
(a-c) The exploration revealed a 13 x 6 cm tumor originating from the pericardium and infiltrating the left ventricle wall. (d) The pericardial ventricle defect was sutured over; a pericardial patch (preclude pericardial membrane PCM Gore) was sutured into the pericardial defect continuously. In the distal part, a 15 x 15 mm gap was left as a pericardial window because of the preexisting pericardial effusion.
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During exploration, a 13 x 6 cm tumor was revealed, extending from the pericardium which infiltrated the left ventricle wall (Figures 2(a)-2(c)). In the distal part, a 15 x 15 mm gap was left as a pericardial window because of the existing pericardial effusion (Figure 2(d)).
(a) Cell tight sections with core types and mitosis (HE color, 200-fold). (b) Immunohistochemistry with CAM 5.2 (cytokeratin 8/18), 100-fold, brown coloration = specific focal positivity. (c) Immunohistochemistry with calretinin, 100-fold, brown staining = diffuse positivity of tumor cells (typical marker for mesothelioma but may also be positive in other sarcomas and tumor entities). (d) Immunohistochemistry MIB-1, Ki67 equivalent, 100-fold, the brown cell nuclei mean positive reaction and indicate the proliferation index.
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In synopsis, however, the morphological, immunophenotypic, and molecular-pathological findings, together with the clinical data, favor a predominantly sarcomoid, malignant mesothelioma, apparently starting from the pericardium (Figures 3(a)-3(d)).