3). Sternotomy was performed, but the mass was not removed successfully due to adhesion to its adjacent large vessels. Histopathologic examinations of specimen obtained during this procedure showed pleomorphic high-grade malignant tumor cells without any definite differentiation features (Fig. 4). Immunohistochemical study showed positive reactivity for vimentin, Vorinostat purchase epithelial membrane antigen (EMA), cytokeratin (CK), CD99 (Fig. 5), but negative reactivity for calretinin, CD56, S-100, chromogranin, Inhibitors,research,lifescience,medical synaptophysin, leukocyte common

antigen (LCA). Although positive reactivity for vimentin and CD99 could suggest the possibility of high-grade sarcoma and Ewing’s sarcoma/primitive neuroectodermal tumor, expression of epithelial differentiation markers of EMA and CK could not be explained in both tumors. Considered histopathologic and immunohistochemical findings, primary pericardial undifferentiated carcinoma was suspected. After 4 months later, TTE demonstrated significantly Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical increased pericardial mass compared with that of before (Fig. 6). Despite several sets of palliative radiation therapy, the patient’s dyspnea was not relieved and expired due to multiple organ failure just within four months after presentation. Fig. 3 Follow-up T2-weighted MR image after 3 month of initial presentation showed that a huge

mass (arrows) about 8×15 cm-sized, settled in transverse sinus was compressing right superior vena cava without evidence of invasion of adjacent vessels. Fig. 4 The tumor cells revealed pleomorphic and hyperchromatic nucleus with epithelioid feature without Inhibitors,research,lifescience,medical any definite differentiation (H&E, ×400). Fig. 5 In immunohistochemical study, tumor cells showed positive reactivity for EMA Inhibitors,research,lifescience,medical (A), CK (B), vimentin (C), and CD99 (D). EMA: epithelial membrane antigen, CK: cytokeratin. Fig. 6 Follow-up transthoracic echocardiography after 4 month of initial presentation revealed an increased huge mass (arrows) of inhomogenous Casein kinase 1 echogenecity that was located in juxtaaortic

valve area. Discussion We present an unusual case of rapidly progressive pericardial undifferentiated carcinoma. Primary cardiac tumors are rare, with an incidence of 0.02%.1) Majority of these tumors are benign, with myxoma comprising 50% of primary cardiac tumors. Malignant tumors account for 25% of primary cardiac tumors. Sarcoma is most common and accounting for 20% of primary malignant cardiac tumors. They are often poorly differentiated, making an exact histologic diagnosis difficult.2) The 2 most common types of sarcomas are angiosarcomas and undifferentiated sarcomas. Other groups include leiomyosarcomas, malignant fibrous histiocytomas, osteosarcomas, and fibrosarcomas.