An autopsy case of diffuse malignant mesothelioma of the pericardium

Our plain-English summary of An autopsy case of diffuse malignant mesothelioma of the pericardium, by N. Sakuma, T. Kamei, T. Unoki, et al (Pathology International, 1997).

The study

• Authors: N. Sakuma, T. Kamei, T. Unoki, H. Okamura, T. Ishihara
• Journal: Pathology International
• Published: 1997;47(1):64-7
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A report is presented of an autopsy case of a 71-year-old Japanese man with a diffuse malignant epithelial mesothelioma of the pericardium with massive pericardial effusion and a thickened pericardium. He had no history of exposure to asbestos. He suffered severe heart failure and later died. Autopsy revealed that the tumor had developed over the pericardium. Microscopically, the tumor cells were arranged in an epithelial form, and histochemically, the cytoplasm of these cells contained glycogen and hyaluronic acid. The tumor tissue showed immunohistochemical positivity for cytokeratin, epithelial membrane antigen, vimentin, cancer antigen 125, thrombomodulin, mesothelial antigen, muscle actin and human milk fat globule. In contrast, all the tumor cells were negative for human carcinoembryonic antigen and epithelial antigen. Ultrastructurally, the tumor cells had long, thin microvilli, abundant intermediate filaments, intracytoplasmic lumina and long desmosomes. It is considered that the patient had a typical malignant epithelial mesothelioma of the pericardium.

In plain English

This case report described one 71-year-old Japanese man admitted to Yamaguchi Central Hospital in January 1989 with fatigue and shortness of breath lasting more than 6 months. The article states he had no history of exposure to asbestos. A CT scan showed a large fluid collection around the heart and a pericardium (the sac around the heart) thickened to 2.5 cm. The fluid was drained and the pericardium was surgically opened. He stayed on diuretic treatment and died 7 months after admission. At autopsy, a tumor in the mediastinum surrounded the heart and was continuous with the pericardium. A separate tumor in the right kidney was a different cancer, transitional cell carcinoma. In tissue tests, the tumor cells had an epithelial pattern and contained glycogen and hyaluronic acid. They were positive for markers including cytokeratin and mesothelial antigen, and negative for CEA and epithelial antigen. Electron microscopy showed long, thin microvilli and giant desmosomes. The authors concluded this was a typical malignant epithelial mesothelioma of the pericardium. The report describes one patient only.

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 71-year-old Japanese man admitted to Yamaguchi Central Hospital (Hofu, Japan) in January 1989
• Exposure: The article reports no history of asbestos exposure. No fiber type or exposure measurement is reported.
• Main results:
  • On CT scans the patient's pericardium was thickened to 2.5 cm, and part of the left pleura was markedly thickened.
  • The patient was treated with fluid drainage, pericardiotomy and diuretics. He died 7 months after admission.
  • At autopsy the tumor filled the pericardial space and was continuous with the pericardium. Both lungs were compressed by about 800 mL of bloody pleural fluid.
  • A separate papillary tumor in the right kidney was transitional cell carcinoma (Grade II), different from the mediastinal tumor.
  • The tumor cells contained glycogen and hyaluronic acid.
  • The tumor tissue was negative for CEA and epithelial antigen. It was positive for cytokeratin, EMA, vimentin, CA125, thrombomodulin, mesothelial antigen, muscle actin and HMFG2.
  • Under the electron microscope the cells had long thin microvilli, abundant intermediate filaments, intracytoplasmic lumina and giant desmosomes.
• The authors' conclusion: The authors concluded that the case was a typical malignant epithelial mesothelioma of the pericardium.
• Limitations the authors state:
  • The authors noted that even a complete autopsy cannot always find microscopic adenocarcinomas growing in other organs, which can be confused with pericardial mesothelioma.

Topics

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

Medical terms in this study, explained in our Lexicon: Autopsy, Malignant Mesothelioma, Pericardium, Mesothelioma, Pericardial Effusion, Hyaluronic Acid, Epithelial Membrane Antigen (EMA), Carcinoembryonic Antigen (CEA).

Related studies

• Letter: Mesothelioma of the pericardium with cholesterol pericarditis — E. Argianas, K. Melissinos, et al. (1974)
• Primary malignant mesothelioma of the pericardium — J. Patel, M.N. Sheppard (2011)
• Malignancies involving the pericardium — W.H. Warren (2000)
• Post-irradiation pericardial malignant mesothelioma: an autopsy case and review of the literature — M. Bendek, M. Ferenc, et al. (2010)
• An autopsy case of a malignant pericardial mesothelioma in a Japanese young man — M. Watanabe, H. Suzuki, et al. (1999)
• The role of liquid-based cytology and ancillary techniques in pleural and pericardic effusions: an institutional experience — E.D. Rossi, T. Bizzarro, et al. (2015)

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