Spindle cell sarcoma of the pericardium: a case report

Malignancy of the pericardium is a very rare entity. We describe here a case of a 38-year-old male admitted because of chest pain and shortness of breath. Following magnetic resonance imaging and CT-guided biopsy of the mediastinal mass, spindle cell sarcoma of the pericardium was diagnosed. The tumor was deemed unresectable due to invasion of vital mediastinal structures. The patient then underwent neoadjuvant chemotherapy with three cycles of ifosfamide, doxorubicin, and mesran. This resulted in a noticeable reduction in tumor size confirmed by follow-up magnetic resonance imaging and repeat transesophogeal echo. Both studies showed marked reduction in tumor bulk with no obvious invasion of the left atrium or pulmonary veins. The pericardial mass was resected utilizing cardiopulmonary bypass through a left thoracotomy in order to remove the tumor from the superior pulmonary veins and pulmonary hilum. The patient was discharged on postoperative day 6. Spindle cell sarcoma of the pericardium is a very rare tumor and other pericardial sarcomas may be best treated by combined neoadjuvant therapy followed by aggressive surgical resection when necessary, possibly utilizing cardiopulmonary bypass.