An autopsy case of a malignant pericardial mesothelioma in a Japanese young man

Our plain-English summary of An autopsy case of a malignant pericardial mesothelioma in a Japanese young man, by M. Watanabe, H. Suzuki, K. Fukutome, et al (Pathology International, 1999).

The study

• Authors: M. Watanabe, H. Suzuki, K. Fukutome, A. Enoki, N. Yamada, T. Nakano, T. Shiraishi, R. Yatani
• Journal: Pathology International
• Published: 1999;49(7):658-62
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

An autopsy case of a malignant pericardial mesothelioma in a 27-year-old man with no history of exposure to asbestos is reported. He was admitted for heart failure due to pericardial effusion of unknown origin and surgically drained, but later died. The diagnosis of a malignant pericardial mesothelioma was made on the basis of histologic, immunohistochemical and ultrastructural findings. The tumor was located on the pericardium, but autopsy revealed that it had spread extensively in the mediastinum and the lungs. Microscopically, the tumor cells were epithelial like and contained histochemically demonstrable glycogen and hyaluronic acid. Immunohistochemical studies of the tumor demonstrated positive immunoreactivity for cytokeratin 19, muscle actin HHF35, epithelial membrane antigen, CA125, p53 and p21WAF1/CIP1 whereas the tumor was negative for cytokeratins 10 and 17, carcinoembryonic antigen, vimentin, epithelial antigen BerEP4, S-100, c-erbB2 and bcl-2. A high MIB-1 labeling index was noted. Under the electron microscope the tumor cells exhibited long, thin villi. The operation and autopsy findings thus revealed this to be a very rare case of malignant pericardial mesothelioma in a young man.

In plain English

This case report from Mie University, Japan, described one patient: a 27-year-old Japanese office worker. In September 1996 the patient had palpitations from fluid around the heart (pericardial effusion) of unknown cause, and the fluid was drained. Symptoms returned in January 1997. Scans showed thickening of the entire pericardium, and tissue tests led to a diagnosis of malignant mesothelioma. The patient died five months after admission. At autopsy, the tumor encased the heart and had invaded or spread to the mediastinum, diaphragm and lungs. Repeated interviews found no history of asbestos exposure, and no asbestos bodies were found in the lung, pleura or pericardium. Microscope, staining and electron-microscope findings matched the epithelial form of mesothelioma. A cell-growth marker (MIB-1) labeled 42.0% of tumor cells. The authors concluded this was a very rare case of malignant pericardial mesothelioma in a young man. They noted that a contribution from asbestos could not be completely ruled out without mineral analysis of lung tissue.

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 autopsy case)
• Who was studied: One 27-year-old Japanese man who worked in an office, treated in Tsu, Japan (Seikyo Hospital, then Mie University Hospital), 1996 to 1997
• Exposure: No history of exposure to asbestos was found. Repeated interviews also found no non-occupational hazards. No fiber type or product is reported.
• Main results:
  • The patient died five months after admission to Mie University Hospital.
  • At autopsy, the primary tumor had grown around the heart and extensively invaded or metastasized to the mediastinum, diaphragm and lungs.
  • No asbestos bodies were detected in the lung, the pleura or the pericardium, even with careful examination of multiple sections.
  • Questioning about family history, about the patient's house, and pathologic examination of the lungs showed no asbestos exposure.
  • Tumor cells showed no immunoreactivity for cytokeratins 10 and 17, CEA, vimentin, BerEP4, S-100, c-erbB2 and bcl-2. They were positive for EMA, cytokeratin 19, muscle actin HHF35, p53, p21 and (weakly, in a small number) CA125.
  • The MIB-1 labeling index (a cell proliferation marker) in the tumor was 42.0%.
  • Under electron microscopy, the tumor cells showed features of the epithelial form of malignant mesothelioma, including long microvilli. Spindle cell components and biphasic patterns were not observed under the light microscope.
• The authors' conclusion: The authors concluded that the operation and autopsy findings showed this to be a very rare case of malignant pericardial mesothelioma in a young man. They considered a pericardial origin confirmed because no primary tumors were found in any other organ.
• Limitations the authors state:
  • A contribution from asbestos could not be completely precluded without mineral analysis of lung tissue extract.
  • The authors did not analyze p53 mutations and had no information about how p21WAF1/CIP1 was induced.
  • The case did not fulfill the Anderson and Hansen diagnostic criteria for malignant pericardial mesothelioma, because the tumor had spread to the gastric lymph nodes and lung by the time of autopsy.

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: Autopsy, Pericardial Mesothelioma, Pericardial Effusion, Pericardium, Mediastinum, Hyaluronic Acid, Epithelial Membrane Antigen (EMA), Carcinoembryonic Antigen (CEA).

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