A second case of pericardial mesothelioma mimicking systemic lupus erythematosus in the literature in over 30 years: a case report

Our plain-English summary of A second case of pericardial mesothelioma mimicking systemic lupus erythematosus in the literature in over 30 years: a case report, by C. Mensi, A. Romano, A. Berti, et al (Journal of Medical Case Reports, 2017).

The study

• Authors: C. Mensi, A. Romano, A. Berti, R. Dore, L. Riboldi
• Journal: Journal of Medical Case Reports
• Published: 2017;11(1):85
• Type of article: Case report
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Mesothelioma is a rare neoplasm which commonly develops in the pleura of people exposed to asbestos. Pericardial mesothelioma accounts for only 0.7 % of all malignant mesotheliomas and it usually presents with pericardial effusion, mimicking serositis. To date, there are approximately 200 cases of pericardial mesothelioma described in the medical literature, and little knowledge exists about the systemic manifestations of this pathology. The first and only described case of pericardial mesothelioma with autoimmune features dates back to 1984 and, in our case report, we describe the second.

Case Presentation: We report a case of a 45-year-old white woman whose pericardial mesothelioma was initially misdiagnosed as pericardial involvement of an autoimmune disease (systemic lupus erythematosus). After several relapses of pericardial effusion, a computed tomography scan and a biopsy with histological analysis were performed revealing neoplastic growth.

Conclusions: We describe a rare case of pericardial mesothelioma in a patient with a clinical presentation compatible with lupus serositis. Clinicians should consider malignant mesothelioma in the differential diagnosis of pericardial effusion, especially when it is recurrent and not clearly explained by other causes. Cytological samples should always be obtained and, if imaging tools are suggestive for solid processes, histological confirmation is mandatory.

In plain English

This case report described a 45-year-old white woman in Italy, a non-smoker, with pericardial mesothelioma (cancer of the heart's lining). The case was reported to the Lombardy Mesothelioma Registry; the authors stated the patient had not been exposed to asbestos. The patient was first hospitalized in 2011 with pericarditis and fluid around the heart. Over the next two years the patient developed arthritis, a sun-sensitive rash, sicca syndrome and repeated pericardial effusions, and was initially misdiagnosed with systemic lupus erythematosus; the authors judged the picture closer to a cancer-related syndrome than to primary lupus. Steroid treatment did not fully resolve the pericardial disease. Cytology and culture tests on the pericardial fluid were negative; the authors noted that cytology often fails to detect mesothelioma. In 2014 a CT scan showed extensive, irregular thickening of the pericardium. Tissue removed at a pericardiectomy confirmed epithelioid pericardial mesothelioma. The tumor was too advanced to be surgically removed; chemotherapy with cisplatin and pemetrexed brought no clinical benefit, and the patient died 8 months later. The authors concluded that clinicians should consider pericardial mesothelioma when pericardial effusion keeps returning without a clear explanation.

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), analyzed retrospectively
• Who was studied: one 45-year-old white woman, a non-smoker, treated in Italy between 2011 and 2014 and reported to the Lombardy Mesothelioma Registry
• Exposure: The authors state the patient had not been exposed to asbestos; no fiber type or occupational exposure is reported
• Main results:
  • After the first hospitalization (2011), the patient developed non-erosive polyarthritis, photosensitive rash, sicca syndrome and repeated pericarditis with pericardial effusion
  • The patient's pericardial mesothelioma was initially misdiagnosed as pericardial involvement of systemic lupus erythematosus
  • The authors interpreted the clinical picture as resembling a paraneoplastic syndrome rather than a primary connective tissue disease
  • Cytological and culture analysis of pericardial fluid obtained by pericardiocentesis was negative
  • The authors noted that cytology has low sensitivity for diagnosing malignant mesothelioma
  • The patient's ESR was consistently above normal while CRP stayed within normal range
  • A CT scan of the chest showed extensive, irregular thickening of both pericardial layers surrounding the heart and major vessels
  • Histological analysis after pericardiectomy confirmed epithelioid pericardial mesothelioma
  • The tumor was too advanced to be eligible for surgical removal, and heart and aortic involvement ruled out radiotherapy
  • The patient was treated with cisplatin and pemetrexed without clinical benefit and died 8 months later
• The authors' conclusion: The authors concluded that clinicians should consider malignant mesothelioma, and in particular pericardial mesothelioma, in the differential diagnosis of pericardial effusion, especially when it is recurrent and not clearly explained by other causes

Topics

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

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Mesothelioma, Neoplasm, Pleura, Malignant Mesothelioma, Pericardial Effusion, Pathology, Pericardial.

Related studies

• Occupational exposures and risk of systemic lupus erythematosus — C.G. Parks, G.S. Cooper (2005)
• Asbestosis and systemic lupus erythematosus — P. Bartsch, J. Salmon, et al. (1980)
• Pericardial Mesothelioma in a 35-Year-Old Male With Ulcerative Colitis — J. Iliff, N.K. Bart, et al. (2019)
• A Rare Case of Malignant Mesothelioma Presenting with Systemic Lupus Erythematosus Seropositivity: A Case Report and Review of Literature — A. Rakhra, A. Munir, et al. (2019)
• Pericardial synovial sarcoma, a potential for misdiagnosis: clinicopathologic and molecular cytogenetic analysis of three cases with literature review — Y. Cheng, W. Sheng, et al. (2012)
• Malignant pericardial mesothelioma. Report of two cases, review of the literature and differential diagnosis — M. Papi, G. Genestreti, et al. (2005)

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