A Case Report of Primary Pericardial Malignant Mesothelioma Treated with Pemetrexed and Cisplatin

Our plain-English summary of A Case Report of Primary Pericardial Malignant Mesothelioma Treated with Pemetrexed and Cisplatin, by J.S. Kim, S.Y. Lim, J. Hwang, et al (Journal of Korean Medical Science, 2017).

The study

• Authors: J.S. Kim, S.Y. Lim, J. Hwang, E.J. Kang, Y.J. Choi
• Journal: Journal of Korean Medical Science
• Published: 2017;32(11):1879-1884
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary pericardial malignant mesothelioma (PPM) is a very rare malignancy, with an incidence of less than 0.002% and represents less than 5% of all mesotheliomas. The cause of pericardial mesothelioma is uncertain that differ from pleural mesothelioma which is associated with asbestos exposure. This malignancy is terribly aggressive and has very poor prognosis with less than six months of overall survival. We present a case of a 71-year-old woman who was diagnosed with cardiac tamponade caused by PPM and received chemotherapy with pemetrexed and cisplatin for six months. During two years she was alive without disease progression. To better understand the clinical, pathologic features and treatment outcome of this entity, we reviewed 23 cases described in the English literature from 2009, together with our case, provided a total of 24 cases. Based on this review, we suggest that PPM must be considered in patients who have unexplained massive pericardial effusion and recommend chemotherapy with pemetrexed and cisplatin for the better outcome of PPM.

© 2017 The Korean Academy of Medical Sciences.

In plain English

This was a case report of one patient plus a review of published cases of primary pericardial malignant mesothelioma (PPM), a cancer of the heart's lining. The patient was a 71-year-old woman who had never smoked. She had no reported occupational, incidental, or indirect (through her husband) asbestos exposure. Fluid around her heart was first seen in 2014. In August 2015 she developed cardiac tamponade, and over 2,300 mL of fluid was drained. Fluid cytology was negative, but a pericardial biopsy showed malignant mesothelioma. The tumor was judged inoperable. After 7 cycles of pemetrexed and cisplatin over 6 months her disease was stable, and she was alive with supportive care 20 months after first symptoms. In the 24 cases reviewed, including hers, 3 (12.5%) had known asbestos exposure, which the authors said implied no obvious relationship. Survival information was missing for 2 cases; the authors reported a median survival from symptoms of 8 months. Treated patients lived longer than untreated ones (median 27 vs. 1.5 months; P = 0.003); 8 of the 11 treated received pemetrexed-containing regimens. The authors concluded pemetrexed and platinum could be considered as a treatment option.

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 of one patient plus a review of published cases of primary pericardial malignant mesothelioma from 2009 through April 2016
• Who was studied: One 71-year-old woman first admitted in September 2014 with dyspnea, dizziness and weight loss. The review covered 24 cases of PPM including hers: 14 male and 10 female, median age 60.5 (range 27 to 85).
• Exposure: The patient had no history of occupational, incidental, or indirect (through her husband) asbestos exposure. She was treated with palliative chemotherapy with pemetrexed and cisplatin.
• Main results:
  • In the patient, over 2,300 mL of pericardial fluid was removed by emergency pericardiocentesis. Pericardial fluid cytology was negative for malignancy.
  • In the patient, excisional biopsy of the pericardium led to a diagnosis of PPM.
  • In the patient, the tumor was judged inoperable. After 7 cycles of pemetrexed and cisplatin over 6 months, the disease remained stable.
  • The patient was alive with best supportive care 20 months after her first clinical manifestation.
  • Of the 24 reviewed cases, 3 (12.5%) had known asbestos exposure. The authors said this implied no obvious relationship between asbestos exposure and PPM.
  • In the reviewed cases, cytology was decisive in only 5 cases (sensitivity 20.8%).
  • In the reviewed cases, epithelial, biphasic and sarcomatoid patterns were reported in 12, 5 and 6 cases respectively.
  • In the reviewed cases, 11 patients received any treatment, and 8 of them received a pemetrexed-containing regimen.
  • Survival information was missing for 2 of the 24 cases. The authors reported a median survival from symptoms of 8 months.
  • Treated patients had longer median survival than untreated patients: 27 vs. 1.5 months, P = 0.003. The survival curve compares treated with not treated patients.
• The authors' conclusion: The authors concluded that PPM should be considered in patients with unexplained massive pericardial effusion, and that chemotherapy with pemetrexed and platinum could be considered as a treatment option.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pericardial, Malignant Mesothelioma, Pemetrexed (Alimta), Cisplatin, Mesothelioma, Pericardial Mesothelioma, Pleural Mesothelioma, Asbestos Exposure.

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