The heart in peritoneal and mesothelial tumors

HEART: Mesothelioma: Gross natural color external view with white plaques over epicardium apparently spread from left side pleura

HEART: Heart, metastatic mesothelioma

HEART: Heart, metastatic mesothelioma

HEART: Heart, metastatic mesothelioma

HEART: Heart, metastatic mesothelioma

HEART: Heart, metastatic mesothelioma

MALIGNANT MESOTHELIOMA: PERICARDIUM Note the gross tumor studding the epicardial surface.

MALIGNANT MESOTHELIOMA: PERICARDIUM There is studding of the pericardium with tumor deposits. The patient was a 50-year-old man with a 2-year history of pericarditis (progressing) to pericardial constriction

MALIGNANT MESOTHELIOMA: PERICARDIUM There is total encasement of the atria and left ventricles by firm, white tumor.

MALIGNANT MESOTHELIOMA: PERICARDIUM There is a partly necrotic mass on the surface of the epicardium.

MALIGNANT MESOTHELIOMA, EPITHELIOID TYPE: PERICARDIUM A higher magnification of figure 14-4 demonstrates a predominantly epithelioid tumor forming papillary structures on the pericardial surface (left) and tubules infiltrating stroma (right).

MALIGNANT MESOTHELIOMA, EPITHELIOID TYPE: PERICARDIUM A higher magnification of figure 14-5 demonstrates papillary areas.

MALIGNANT MESOTHELIOMA, EPITHELIOID TYPE: PERICARDIUM The tumor infiltrates as tubules which histologically mimic adenocarcinoma.

MALIGNANT MESOTHELIOMA, EPITHELIOID TYPE: PERICARDIUM The patient was a 66-year-old male with a known history of asbestos exposure and pleural plaques who developed diffuse pericardial tumor. A low magnification view shows a section of pericardium that is markedly thickened.

EPITHELIOID TYPE: PERICARDIUM: An epithelioid neoplasm mimicking carcinoma. A primary carcinoma was ruled out at autopsy.

MALIGNANT MESOTHELIOMA, BIPHASIC TYPE: PERICARDIUM: This tumor has epithelioid cells (lower half) surrounded by spindled cells. The patient was a 46-year-old woman with constrictive pericarditis; the pericardium was studded with coalescing tumor nodules.

MALIGNANT MESOTHELIOMA: PERICARDIUM A higher magnification of a different area of the tumor depicted in figure 14-10 shows biphasic tumor mimicking desmoplastic adenocarcinoma.

MALIGNANT MESOTHELIOMA: PERICARDIUM The spindled and epithelioid areas may merge, imparting a sarcomatoid appearance. The patient was a 56-year-old woman with pericardial tamponade and diffuse pericardial tumor surrounding the root of the aorta.

MALIGNANT MESOTHELIOMA: PERICARDIUM Immunohistochemical stain reveals epithelioid areas that strongly express cytokeratin; the spindled cells are often less strongly reactive for this antibody.

MALIGNANT MESOTHELIOMA: PERICARDIUM The patient was a 69-year-old man who died shortly after open thoracotomy to relieve pericardial constriction. There were multiple tumor nodules on the epicardial surfaces of both atria, enveloping the aortic root. This tumor has a histologic appearance reminiscent of an adenomatoid tumor.

MALIGNANT MESOTHELIOMA: PERICARDIUM A higher magnification of figure 14-14 demonstrates irregular spaces suggestive of adenomatoid tumor.

HEART-GREAT VESSELS: MALIGNANT MESOTHELIOMA: PERICARDIUM Electron micrograph demonstrates elongated microvilli characteristic of mesothelial differentiation.

METASTATIC ADENOCARCINOMA: PERICARDIUM Intracytoplasmic globules containing PAS-positive material are seen in adenocarcinoma and are absent in mesothelioma and reactive mesothelial cells. (Periodic acid-Schiff after diastase pretreatment).