A peculiar presentation of tamponade: pericardial mesothelioma

Our plain-English summary of A peculiar presentation of tamponade: pericardial mesothelioma, by S.D. Syed Ahmad, F. Kirk, W. Wijesinghe, et al (Journal of Surgical Case Reports, 2024).

The study

• Authors: S.D. Syed Ahmad, F. Kirk, W. Wijesinghe, C. He, A. Stroebel
• Journal: Journal of Surgical Case Reports
• Published: 2024;2024(5):rjae279
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Pericardial mesothelioma (PM) is rare with only 200 cases recorded, and a post-mortem prevalence of <0.0022%. It is the third most common cardiac/pericardial tumour, behind angiosarcoma and rhabdomyosarcoma. PM incidence increases with age, typically incidentally diagnosed between 50 and 70 years, with a 3:1 male predominance. Occasional PM can cause chest pain, dyspnoea, cough and even dysphagia. PMs are often misdiagnosed with only 25% of cases being antemortem diagnoses. Unlike pleural mesothelioma, the link between asbestos exposure and malignancy is less convincing, with only 20% of cases having known exposure. 6 There are three histological types: epithelioid, fibrous (spindle cell), and biphasic (mixed). The average life-expectancy post diagnosis is 3-10 months. Due to the heterogeneity of the presentation and rarity there is no standardized management algorithm, and the diagnostic imaging or laboratory investigations are scarcely described. We are presenting one of the cases diagnosed in our unit here in the Gold Coast.

Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.

In plain English

This was a case report from Gold Coast University Hospital in Australia about one patient with pericardial mesothelioma, a cancer of the lining around the heart. A 62-year-old woman had cough, breathlessness and upper right abdominal pain, and was first treated for a respiratory infection. A week later her breathlessness was much worse. Scans showed a large fluid collection around the heart. Draining it removed 2.5 L of fluid, which contained scant atypical mesothelial cells. CT, MRI and PET scans showed a mass in the chest encasing the aorta, with spread to one nearby lymph node. A needle biopsy and a keyhole (VATS) biopsy were not diagnostic, so surgeons sampled the mass again through a partial opening of the breastbone. The fluid then returned and showed signs of pressing on the heart, so a pericardial window was made. Tissue analysis showed epithelioid pericardial mesothelioma, staged T4N1M1, and she was referred to medical oncology. The authors noted she had no smoking or asbestos exposure. They concluded that these tumours are rare and aggressive. The article did not report her outcome.

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 62-year-old woman treated at Gold Coast University Hospital, Australia; no significant medical history
• Exposure: The authors reported an absence of smoking or asbestos exposure in this patient; no fiber type or occupational exposure was described
• Main results:
  • Pericardiocentesis in this patient drained 2.5 L of fluid
  • Cytology of the patient's pericardial fluid showed scant atypical mesothelial cells
  • CT showed a large mediastinal mass encasing the aorta; on PET the lesion was intensely FDG-avid, with an isolated right para-oesophageal nodal metastasis
  • A CT-guided biopsy was insufficient for diagnosis, and a left VATS biopsy was also non-diagnostic
  • At hemi-sternotomy a firm cream-coloured nodular and globular intra-pericardial mass containing gelatinous fluid was found wrapping the ascending aorta
  • After surgery the pericardial effusion recurred with echocardiographic signs of tamponade, and a pericardial window was made via a left VATS approach
  • Immunohistochemistry was positive for calretinin, CK5/6, BAP1 and WT1 and negative for Desmin and TTF-1
  • The diagnosis was pericardial mesothelioma of the epithelioid type, staged T4N1M1, and the patient was referred to medical oncology
• The authors' conclusion: The authors concluded that pericardial mesotheliomas are a rare and aggressive mediastinal tumour whose presentation is often innocuous and incidental. They stated that patients may benefit from a combination of surgery, chemotherapy and radiotherapy depending on the extent of disease.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Pericardial, Dysphagia, Pleural Mesothelioma, Asbestos Exposure, Epithelioid, Spindle Cell, Biphasic Mesothelioma.

Related studies

• Cardiac tamponade as the initial manifestation of primary pericardial mesothelioma — M. Stein, A. Neuman, et al. (1995)
• Sarcomatoid Type Primary Pericardial Mesothelioma with a Long-term Survival after the Onset of Cardiac Tamponade — C. Saisho, H. Ishii, et al. (2016)
• An unusual case of cardiac tamponade following electrical cardioversion — G.A. Jessurun, H.J. Crijns, et al. (1996)
• Idiopathic retroperitoneal fibrosis: prospective evaluation of incidence and clinicoradiologic presentation — E.F.H. van Bommel, I. Jansen, et al. (2009)
• British Thoracic Society study of cryptogenic fibrosing alveolitis: current presentation and initial management. Fibrosing Alveolitis Subcommittee of the Research Committee of the British Thoracic Society — I.D. Johnston, R.J. Prescott, et al. (1997)
• Clinical presentation of peritoneal mesothelioma — Y.I. Acherman, L.S. Welch, et al. (2003)

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