30 yo female, previous dx of breast carcinoma. Pericardial b | Figure 1

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30 yo female, previous dx of breast carcinoma. Pericardial biopsy due to severe and recurrent pericardial effusion. On standard HE sections we see these atypical epithelioid cells with increased nucleus/cytoplasm ratio (almost all of them are nucleus, barely no cytoplasm), highly hyperchromatic nucleus, meaning it is positive to metastatic carcinoma. So, final lesson: recurrent effusions (on any serous membrane: pleura, pericardium, and peritoneum), look for a cause. If previous cancer, especially a carcinoma/lymphoma (sarcomas uncommonly have this behavior), that is a potential cause.