PMC6010620_01
Chest X-ray on admission showing large right pleural effusion.
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He was found to be hypoxemic, and chest radiography revealed a new large right-sided pleural effusion (Fig. 1).
Thorascopic view of right pleura showing the fleshy nodularity that was biopsied.
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Operative findings revealed scattered areas of fleshy nodularity involving the diaphragm and posterior sulcus, most consistent with fat (Fig. 2).
a. Highly atypical, infiltrating epithelioid cells, with focal areas of discohesiveness. H&E stain, 100x magnification; b. Higher power (200x magnification); c. Solid areas of the tumor, showing highly atypical epithelioid cells with numerous mitotic figures (arrows); d. Fli-1 (vascular marker) immunohistochemistry showing expression in tumor cells. CD-31 (another vascular marker) was also positive. The tumor was negative for epithelial, neuroendocrine, and mesothelial markers.
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Immunoperoxidase studies showed reactivity to CD31, FLI-1, AE1/3, OSCAR, WT-1, and D2-40 (Fig. 3).
PET image of FDG-avid pericardium (a) and pleural effusion (b).
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Staging PET scan (Fig. 4) revealed malignant FDG-PET avidity of the pericardium, with a loculated pericardial effusion (SUV max 16.1).