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Endobronchial Ultrasound-guided Intratumoral Injection of Cisplatin for the Treatment of Isolated Mediastinal Recurrence of Lung Cancer
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Primary Pericardial Angiosarcoma Demonstrating Initial Response Followed by Progression on First-Line Chemotherapy: A

Ujjwal Kumar Thakur1, Akash Subedi1, Rheecha Joshi2

  • 1Department of Clinical Oncology Kathmandu Cancer Center Tathali Bhaktapur Nepal.

Clinical Case Reports
|March 9, 2026
PubMed
Summary
This summary is machine-generated.

Primary pericardial angiosarcoma is a rare cancer that can be mistaken for tuberculosis. Early diagnosis and multimodal treatment are crucial for managing this aggressive disease, despite potential for initial chemotherapy response.

Keywords:
cardiac tumorscase reportchemotherapy resistancenepalpericardial angiosarcomatuberculosis

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Area of Science:

  • Oncology
  • Cardiovascular Pathology
  • Diagnostic Imaging

Background:

  • Primary pericardial angiosarcoma is a rare, aggressive malignancy with poor prognosis.
  • Diagnosis is often delayed, especially in tuberculosis-endemic areas, due to overlapping symptoms with tuberculous pericarditis.
  • Non-specific clinical presentation and initial misdiagnosis can significantly impact patient outcomes.

Purpose of the Study:

  • To report a case of primary pericardial angiosarcoma misdiagnosed as tuberculous pericarditis.
  • To highlight the diagnostic challenges in tuberculosis-endemic regions.
  • To emphasize the importance of early histopathological diagnosis and multimodal treatment strategies.

Main Methods:

  • Case report of a 25-year-old male with dyspnea and a large pericardial effusion with an atrial mass.
  • Initial evaluation included imaging (MDCT), GeneXpert testing for tuberculosis, and pericardiocentesis.
  • Diagnosis was confirmed via histopathology after median sternotomy and bilateral pleuropericardial window creation.
  • Treatment involved first-line chemotherapy (ifosfamide, epirubicin) and second-line chemotherapy (nab-paclitaxel, gemcitabine).

Main Results:

  • Initial diagnosis was tuberculous pericarditis based on GeneXpert, but symptoms persisted.
  • Histopathology revealed high-grade angiosarcoma (CD31, CD34, ERG positive; Ki-67 30%).
  • First-line chemotherapy led to significant tumor volume reduction and clinical improvement.
  • Disease progression occurred after completion of first-line chemotherapy, necessitating second-line treatment.

Conclusions:

  • Pericardial angiosarcoma presents diagnostic challenges, particularly in tuberculosis-endemic regions.
  • Malignancy should be considered in cases of hemorrhagic pericardial effusion and cardiac masses.
  • Despite initial chemotherapy response, the disease is aggressive with a high risk of progression.
  • Early histopathological diagnosis and adaptive, multimodal treatment are critical for optimizing outcomes.