PMC8639695_01
Positron emission tomography/computed tomography findings. Intense fluorodeoxyglucose uptake was observed in the pericardium with a maximum standardized uptake value of 9.6.
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F1
The local hospital performed 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET), which showed intense FDG uptake in the pericardium (maximum standardized uptake value: 9.6), the area surrounding the left atrium, and mediastinum (Figure 1).
(A) Conventional echocardiography showed a mass in the pericardium. (B) Contrast echocardiography showed that the mass was hyper-enhancing.
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F2
TTE revealed a homogeneous isoechoic pericardial mass (75 x 30 mm) with massive pericardial effusion (Figure 2A). Compared with the adjacent myocardium, the mass was hyper-enhanced (Figure 2B).
Cardiac magnetic resonance imaging. (A) T2-weighted imaging showed an irregular mass in the pericardium. (B) The signal intensity of the mass was hyperintense on T2-weighted imaging with fat suppression. (C) The diffusion-weighted image was hyperintense. (D) The mass showed irregular enhancement with gadolinium injection on T1-weighted imaging.
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F3
Further cardiac MRI (CMRI) (Figure 3) showed a pericardial mass attached to the wall of the left atrium with invasion to the pericardium and vessels.
Pathological features. (A) Hyperplastic epithelioid cells were arranged in sheets on the surface of the pericardium with an inflammatory background. The cells were positive for (B) calretinin and (C) D2-40 by immunohistochemistry. (D) CDKN2A (p16) deletion was detected by fluorescence in situ hybridization.
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F4
The pericardial biopsy showed that the cells were positive for mesothelial cell markers (calretinin and D2-40) by immunohistochemistry (IHC), and CDKN2A (p16) deletion was detected by fluorescence in situ hybridization (FISH) (Figure 4).