case_images: PMC10694204_01
case_images: Chest image findings before and after 6 cycles of chemotherapy. (A) x-ray image shows cardiomegaly with pericardial effusion and blunted left costophrenic angle. (B) Computed tomography image shows pericardial effusion with noticeable pericardial thickening and bilateral pleural effusion. (C) x-ray image showed normal heart size without pleural effusion. (D) Computed tomography image showed subsiding pericardial effusion and lessened pericardial thickening. White and green arrows indicate the areas of pericardial and pleural effusion, respectively.
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case_images: F1
case_images: Chest x-ray showed cardiomegaly and pericardial effusion (Figure 1A). Computed tomography (CT) scans revealed massive pericardial effusion with thickened pericardium and bilateral pleural effusion (Figure 1B). A follow-up chest x-ray and CT scan immediately after the 6 cycles of chemotherapy on Day 149 revealed normal heart size, no pleural or pericardial effusion (Figure 1C), and lessened pericardial thickening (Figure 1D).
case_images: Pathology findings. Cytopathology analysis of pericardial effusion shows clustered mesothelial cells (A) H&E stain analysis of pericardial biopsy shows atypical mesothelioma cells (B) Immunohistological analysis of pericardial biopsy shows that tumor cells exhibited positive staining of cytokeratin 5/6 (C), retained expression of BRCA1-associated protein 1 (D), and loss of expression of methylthioadenosine phosphorylase (E) Magnifications: 10x in panel (A), 40x in panel (B), and 20x in panels (C-E).
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case_images: F2
case_images: Subsequent cytopathology analysis of pericardial effusion showed clustered mesothelial cells (Figure 2A). Pathological evaluation of the biopsy specimen revealed the presence of several abnormalities, including an overgrowth of mesothelial cells, changes in the nuclei of these cells, increased collagen in the connective tissue, and the accumulation of fibrinoid exudates (Figure 2B). The tumor cells also exhibited a loss of 186 expression of methylthioadenosine phosphorylase and retained 187 expression of BRCA1-associated protein 1 (Figure 2C-2E).
case_images: Findings of positron emission tomography-computed tomography. Sagittal (A) and axial (B) images illustrate diffuse, irregular nodular uptake of fluorodeoxyglucose in the anterior mediastinum with no metastasis. White and green arrows indicate the areas of pericardial and pleural effusion, respectively.
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case_images: F3
case_images: The result showed 18F-fluorodeoxyglucose (FDG) uptake in the anterior part of the mediastinum without distant metastasis (Figure 3).
case_images: Timeline summarizing the major events during the episode of care for the patient. CT, computed tomography; FDG, 18F-fluorodeoxyglucose; PPM, primary pericardial mesothelioma.
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case_images: F4
case_images: The timeline of the major events during the episode of care for this patient is summarized in Figure 4.