Primary Pericardial Sarcoma: A Case Report and a Brief Review

There are very few cases of primary pericardial sarcomas reported in the English literature. Pericardial tumors, like other cardiac tumors, are most likely to be metastatic in nature and are an extension of primary tumors from the surrounding structures. Sarcomas are the most common primary pericardial tumors. Surgical eradication of the tumor is considered to be the treatment of choice. We are presenting a case of a primary pericardial, high-grade pleomorphic undifferentiated sarcoma that was diagnosed at our institution. We discuss the available diagnostic modalities and also shed light on alternative therapies when patients are not ideal surgical candidates. 1. Introduction Cardiac neoplasms are either primary or secondary; in case of secondary neoplasms the most common site of origin is the lung [1]. The cardiac involvement can be endocardial, myocardial, or pericardial, but tumors only involving the parietal pericardium are not considered to be true cardiac tumors. Primary cardiac tumors are rare; the incidence is reported to be around 0.056–0.02% [1]. Malignant tumors involving the pericardium are even rarer in autopsy series, the incidence is reported to be around 0.001%. Pericardial tumors, like other cardiac tumors, are most likely to be metastatic in nature and are an extension of primary tumors from the surrounding structures. Pericardial tumors often cause symptoms related to malignant pericardial effusion. The presenting symptoms are cough, dyspnea, chest pain, and palpitations, which are a result of the mass effect of the tumor on the cardiac chambers [2]. These tumors are of a particular concern due to the fact that overt signs and symptoms occur rather late in the course, precluding effective tumor eradication [2]. We are presenting a case of a primary pericardial, high-grade pleomorphic undifferentiated sarcoma that was diagnosed at our institution and provide a brief insight into the detection and treatment of the disease. 2. Case Presentation A 67-year-old Caucasian gentleman presented to our institution with acute right-sided chest pain. He had been experiencing gradually worsening shortness of breath on exertion for a few months. Physical examination revealed a malnourished moderately built male with tachycardia and muffled heart sounds. Chest radiography revealed a widened mediastinum and an enlarged heart that was suspicious for a pericardial effusion. A transthoracic echocardiogram (TTE) confirmed a large anterior pericardial effusion with respirophasic blunting of the inferior vena cava but no right ventricular diastolic