Primary liposarcoma of the pericardium: report of a rare case with clinicopathological features and imaging insights.

BACKGROUND: Primary cardiac tumors are extremely uncommon, and malignant variants are even rarer. Among them, pericardial liposarcoma is exceptionally infrequent, with very few cases reported worldwide. Because of its nonspecific clinical presentation and the complexity of cardiac anatomy, diagnosis is often delayed. This case is notable due to the tumor’s unusual pericardial origin and demonstrates the critical role of multimodal cardiac imaging in identifying rare primary cardiac malignancies. CASE PRESENTATION: A 56-year-old woman with a history of arterial hypertension and prior SARS-CoV-2 infection presented with progressive dyspnea and chest pain of several weeks’ duration. Physical examination and initial laboratory tests were nonspecific. Transthoracic echocardiography revealed a large heterogeneous pericardial mass. Further evaluation with computed tomography and cardiac magnetic resonance imaging demonstrated a lesion with mixed solid and fatty components, closely associated with the pericardium. Surgical biopsy with histopathological and immunohistochemical analysis confirmed the diagnosis of undifferentiated liposarcoma of probable pericardial origin. The patient was referred for specialized oncologic management; however, her clinical course was unfavorable, and she ultimately experienced disease progression. CONCLUSIONS: This case illustrates the diagnostic challenges associated with rare primary cardiac malignancies and emphasizes the importance of integrated multimodal imaging in characterizing pericardial tumors. Increased clinical awareness and further research are needed to optimize therapeutic strategies and improve outcomes in patients with pericardial liposarcoma.