case_images: PMC10601732_01
case_images: Imaging studies of the cardiac mass (a) transthoracic echocardiography (TTE) revealed a moderate to large pericardial effusion circumferential to the heart, which was largest along the right-sided chambers and posteriorly. Within the pericardial space, posterior to the heart, and abutting the right atrium (RA) and ventricle (RV), was a large mass, measuring 5.5 x 5.9 cm, depicted in this apical view. The left ventricle (LV) was normal in size. b Cardiac MRI detected a heterogeneous mass inferior to the heart in the pericardial space that is intermediate in signal intensity on T1-weighted and T2-weighted images. This mass measured up to 5.9 x 5.8 x 6.2 cm and displaced the heart superiorly.
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case_images: PMC10601732_01_cro-2023-0016-0001-530113_F01.jpg
case_images: F1
case_images: CT imaging and transthoracic echocardiogram were performed and demonstrated a 6.6 x 5.2 cm mass inferior to the heart with a circumferential moderate to large pericardial effusion (Fig. 1a). Cardiac ejection fraction was estimated as 70%, and there was no sign of tamponade physiology or atrial enlargement. MRI also similarly confirmed the presence of this heterogeneous mass posterior to the heart and abutting the right atrium and right ventricle (Fig. 1b).
case_images: Anatomic and histologic pathology of the epithelioid angiosarcoma (a) gross anatomical pathology demonstrated an ovoid-shaped, pink, and tan mass that measured 8.5 x 7.0 x 5.2 cm with a heterogeneous surface. b-d Microscopic examination revealed epithelioid and vascular components, including nests and sheets of polygonal cells with vesicular chromatin, prominent nucleoli, and abundant eosinophilic cytoplasm that were admixed with delicate blood vessels on H&E staining (b), as well as invasion in atrial muscle (c, black arrow) and atypical mitotic figures (d, black arrows, x40). e-i Immunohistochemistry revealed strong positive membranous staining for CD31 (e), positive staining for CD34 (f), focally positive staining for CKAE1/AE3 (pancytokeratin) (g), 10% positive staining for Ki-67 proliferation index (h), and negative nuclear staining for CAMTA1 (i, x40). x20 magnification unless otherwise noted.
case_images: cro-2023-0016-0001-530113_F02.jpg
case_images: PMC10601732_01_cro-2023-0016-0001-530113_F02.jpg
case_images: F2
case_images: On gross examination, the mass measured 8.5 x 7.0 x 5.2 cm and had a heterogenous surface with attached areas of pericardium and inferior vena cava (Fig. 2a). On microscopic examination, the tumor was composed of sheets of atypical polygonal cells with vesicular chromatin, prominent nucleoli, and abundant eosinophilic cytoplasm (Fig. 2b). These cells were admixed with delicate blood vessels, angulated vascular channels and areas of hemorrhage and demonstrated invasion into adjacent atrial muscle (Fig. 2c). On immunohistochemical (IHC) analysis, the neoplastic cells were positive for vimentin, CD31, CD34, and calretinin and weakly positive for pancytokeratin with a Ki-67 index of 10% (Fig. 2e-h).