case_images: PMC8639695_01
case_images: 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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case_images: F1
case_images: 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).
case_images: (A) Conventional echocardiography showed a mass in the pericardium. (B) Contrast echocardiography showed that the mass was hyper-enhancing.
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case_images: F2
case_images: 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).
case_images: 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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case_images: PMC8639695_01_fcvm-08-758988-g0003.jpg
case_images: F3
case_images: 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.
case_images: 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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case_images: F4
case_images: 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).