PMC5873788_01
A) Pericardial effusion in transthoracic echocardiography. B)
Hyperechogenic mass arising from the right atrium and invading the right
ventricle on transthoracic echocardiography in four-chamber view. C)
Axial thoracic computed tomography (CT). D) Coronal thoracic CT. E)
Sagittal thoracic CT; soft tissue lesion (5 cm in size) filling the
right atrial lumen and invading the right ventricle and, partially, the
suprahepatic segment; pericardial and pleural effusion. F) Soft tissue
lesion in left upper mediastinum (white arrow). G)
(18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed
tomography (PET/CT) images demonstrate hypermetabolic mass (SUVmax:
14.29) in the right atrium, bilateral pleural and pericardial effusion,
and mediastinal metastatic lymphadenopathy (SUVmax: 15.07). H) FDG
PET/CT images demonstrate hypermetabolic mass (SUVmax: 15) in the medial
left kidney.
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There was a massive pericardial and moderate right pleural effusion (Figure 1). Echocardiogram showed massive pericardial effusion and a solid tumor in the right atrium expanding towards the right ventricule (Figure 1). (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan revealed increased FDG uptake in the mediastinum and over the heart. Pleural and pericardial effusion and intra-abdominal free fluid were also seen (Figure 1).
A) Mass (M) before right atriotomy. B) Mass infiltrating atrial
appendage (AA). C) Removal of the mass. D) The defect was repaired
by pericardial tissue.. Ao=aorta; P=pericardium; VCS=vena cava superior
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This resected area was repaired by using glutaraldehyde-treated autologous pericardium (0.1%) (Figure 2).
A) Gross pathological picture of the tumor. B) Cellularity and
necrosis of the angiosarcoma (HE, x100). C) Angiosarcoma cells
round, oval, or spindle shaped (arrow) (HE, x200). D) Tumor cells
(arrow) were immunohistochemistry cytoplasmic stained by cluster of
differentiation 34 (CD34, x200). E) Tumor cells (arrow) show nuclear
positive immunohistochemical staining with friend leukemia
integration-1 (FLI-1) (CD34, x100).
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On immunohistochemical analysis, tumor cells were positive for cluster of differentiation 31 (CD31), CD34, friend leukemia integration-1 (FLI-1) and erythroblast transformation specific regulated gene-1 (ERG), but they were negative for keratin, desmin, smooth muscle actin (SMA), myogenin, Human melanoma black 45 (HMB45) and human herpesvirus 8 (HHV-8) (Figure 3).