18F-fluorodeoxyglucose imaging of primary malignant pericardial mesothelioma with concurrent pericardial and pleural effusions and bone metastasis: A case report

Our plain-English summary of 18F-fluorodeoxyglucose imaging of primary malignant pericardial mesothelioma with concurrent pericardial and pleural effusions and bone metastasis: A case report, by X. Li, R. Lu, Y. Zhao, et al (Molecular and Clinical Oncology, 2018).

The study

• Authors: X. Li, R. Lu, Y. Zhao, F. Wang, G. Shao
• Journal: Molecular and Clinical Oncology
• Published: 2018;8(6):725-728
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary malignant pericardial mesothelioma (PMPM) is an aggressive tumor that originates from the mesothelial cells of the pericardium. PMPM with extensive atrial infiltration and bone metastasis is extremely rare. The diagnosis and staging of PMPM based on anatomical imaging may be difficult when concurrent pericardial and pleural effusions are present. A 28-year-old man presented with progressive chest pain. Concurrent pericardial and pleural effusions were identified on computed tomography. On echocardiography, mild thickening and adhesions of the pericardium with the right ventricle and atrium were observed. 18F-fluorodeoxyglucose (FDG) metabolism imaging revealed increased accumulation in the pericardium and adjacent right atrium. Ring-shaped radioactivity aggregation and bone destruction in the sacrum were demonstrated on 18F-FDG and 99mTc-methyl diphosphonate imaging. The diagnosis of PMPM was subsequently confirmed by pathology. The patient survived for >1.5 years with comprehensive treatment.

In plain English

This article is a case report about one patient, a 28-year-old man admitted to Nanjing First Hospital, China, in May 2010. He had four months of worsening left-sided chest pain and breathlessness. He had smoked for 10 years, and the authors reported no history of tuberculosis or asbestos exposure. Scans showed a large fluid collection around the heart (pericardial effusion) and a smaller one around the lungs (pleural effusion). Of this fluid, 1,800 ml was drained from around the heart; it showed only reactive mesothelial cells, not tumor cells. Tuberculosis drugs had a poor effect. An 18F-FDG scan showed highly increased uptake in the right atrium and nearby pericardium. FDG and bone scans showed a destructive lesion in the sacrum, read as a bone metastasis. A biopsy confirmed primary malignant pericardial mesothelioma with atrial infiltration. He received six cycles of pemetrexed and cisplatin. Lung metastases and a large pleural effusion appeared one year after surgery. He died in September 2012, more than 1.5 years after diagnosis. The authors concluded that 18F-FDG imaging may be a particularly useful tool for diagnosis, staging and response evaluation in this disease.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (single patient)
• Who was studied: One 28-year-old man admitted to Nanjing First Hospital, China, in May 2010 with progressive left-sided chest pain and breathlessness; 10-year smoking history (1 pack/day)
• Exposure: No asbestos exposure was reported for this patient (and no history of tuberculosis); the patient had a 10-year history of smoking 1 pack per day
• Main results:
  • Imaging showed a large pericardial effusion together with a little-to-moderate pleural effusion in the patient
  • 1,800 ml of pericardial fluid was drained; cytology of the fluid found only reactive mesothelial cells, without acid-fast bacilli or tumor cells
  • Treatment with antituberculosis drugs (isoniazid and rifampin) had a poor effect and the pericardial effusion increased
  • 18F-FDG imaging showed highly increased uptake in the right atrium and the pericardium next to the right ventricle and atrium, with mildly increased uptake along the inner chest wall
  • 18F-FDG imaging and a 99mTc-MDP bone scan showed a destructive (osteolytic) metastasis in the sacrum
  • Pericardial biopsy confirmed primary malignant pericardial mesothelioma with atrial infiltration
  • After surgery the patient received pemetrexed 500 mg/m2 plus cisplatin 75 mg/m2 on day one of each 3-week cycle, for six cycles
  • Lung metastasis and a large pleural effusion were seen 1 year after the operation
  • The patient survived more than 1.5 years after diagnosis and died of severe pericardial effusion and cardiac tamponade in September 2012
• The authors' conclusion: The authors concluded that 18F-FDG imaging may be a particularly useful tool for early diagnosis, staging and response evaluation in patients with primary malignant pericardial mesothelioma

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Pericardial, Pleural Effusion, Metastasis, Mesothelial Cells, Pericardium, Staging, Pathology.

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