This is the case of a 91 year old woman who presented with pericardial tamponade, effusions and pericardial and epicardial nodules (identified on CAT scan).

She had a history of chronic lymphocytic leukemia since 1999 and recurrent pleural effusions (confirmed by flow cytometry), and colon cancer with resection in 1997. Pericardial window was performed, and the pericardial nodules were biopsied to rule out metastatic carcinoma. Gross exam showed a thickened, edematous and nodular pericardium with multiple discrete round surface nodules ranging from 0.3 to 0.7 cm.

Pericardial Biopsy

Image 1: One representative section of the pericardial biopsy, showed a diffuse small lymphocytic infiltrate
and a separate atypical nodule.


Image 2: A close-up of the same small lymphocytic infiltrate.


Image 3: A low-power magnification of a representative pericardial nodule, showing a nodular, fibrotic
architecture.


Image 4: Close-up of one of the nodules, showing broad bands of sclerotic stroma.

Image 5: Higher magnification of the nodule, showing a mixed inflammatory background including many
eosinophils, plasma cells, and large atypical cells.


Image 6: Highest magnification, showing an atypical binucleated cell.

Image 7: Higher magnification, showing additional atypical cells..

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