Case report and analysis of the literature on sarcomatous mesothelioma of the left atrium

Our plain-English summary of Case report and analysis of the literature on sarcomatous mesothelioma of the left atrium, by W. Rouabeh, T. Cherif, I. Mgarrech, et al (International Journal of Surgery Case Reports, 2023).

The study

• Authors: W. Rouabeh, T. Cherif, I. Mgarrech, N. Ajmi, C. Kortas, S. Jerbi
• Journal: International Journal of Surgery Case Reports
• Published: 2023;109:108537
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction And Importance: Primary intracardiac malignant mesothelioma is an extremely uncommon condition with a terrible prognosis. Because of its rarity, there have been extremely few examples described in the literature.

Case Presentation: We are reporting the instance of a 44-year-old lady who was referred to the department of cardiology for worsening dyspnea, palpitations, and a recent syncopal episode. On examination, the patient had signs of global heart failure. Cardiac imaging showed a tissue mass infiltrating the atrioventricular sulcus at the mitral valve level, responsible for severe mitral stenosis. Pleural effusion without an intrapleural mass was also noted. Urgent surgery was performed, including excision of the tumor mass, mechanical replacement of the mitral valve, and tricuspid plasty. The anatomo-pathological study concluded in cardiac mesothelioma. The patient was transferred back to the cardiology department 9 months after surgery due to severe left heart failure. TTE and TOE were performed and revealed tumor recurrence responsible for severe mitral stenosis. The course was marked by the onset of cardiogenic shock refractory to treatment, followed by the death of the patient. The case we are reporting seems to be the initial instance documented as exclusively primary intracardiac mesothelioma especially its lack of association with any other pleural sarcomatoid mesothelioma or asbestos exposure.

Clinical Discussion: In cases where a large atrial tumor is present, prompt surgical intervention is recommended to mitigate the risk of catastrophic embolization or valve orifice obstruction. The objective of surgical intervention is to excise the entire neoplasm with sufficient surrounding tissue, a feat that is infrequently achievable. Palliative debulking may be a beneficial intervention for patients who do not necessitate complete resection, particularly those experiencing relevant or rapidly escalating symptoms. Cardiac transplantation remains a viable option in the event of an unresectable malignant tumor.

Conclusion: The short-term prognosis is poor. Surgical treatment remains the best treatment for this type of tumor. Total excision should be considered, but may not be feasible in all cases. Adjuvant chemotherapy may be considered.

Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

In plain English

This case report, from a cardiovascular and thoracic surgery department in Sousse, Tunisia, described a 44-year-old woman referred for worsening shortness of breath, palpitations and a recent fainting episode. Imaging showed a mass in the left atrium of the heart that extended to the mitral valve and blocked its opening. In urgent surgery, a 4 cm-wide white mass was removed together with the mitral valve, which was replaced by a mechanical valve. Tissue examination confirmed malignant sarcomatous mesothelioma. The patient was discharged on the tenth day after surgery and had no breathlessness or palpitations three months later. Nine months after surgery, during chemotherapy, she developed severe left heart failure because the tumor had come back. She died of cardiogenic shock that did not respond to treatment. In the article's abstract, the authors wrote that the case appeared to be the first documented as exclusively primary intracardiac mesothelioma, with no association with pleural sarcomatoid mesothelioma or asbestos exposure. The authors concluded that early detection and surgical removal remain the most successful therapy, though this is seldom achieved.

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 44-year-old woman with no previous history of cardiovascular illness, treated at Sahloul Hospital, Sousse, Tunisia; dates of treatment not given
• Exposure: No asbestos exposure is reported. The authors state, in the article's abstract only, that the case lacked association with asbestos exposure. No fiber type or exposure history is described.
• Main results:
  • On echocardiography, a large mass in the left atrium, attached to the side wall, blocked the mitral valve, with a mean pressure gradient of 18 mmHg
  • On MRI the mass measured 2.5 to 3 cm
  • At surgery a 4 cm-wide white mass arising from the posterior leaflet of the mitral valve was found. The tumor and mitral valve were removed and the valve was replaced with a mechanical prosthesis.
  • Examination of the removed tissue confirmed malignant sarcomatous mesothelioma
  • The patient was discharged on the tenth day after surgery
  • Nine months after surgery, during chemotherapy, echocardiography showed the tumor had recurred, causing significant mitral stenosis
  • The patient developed cardiogenic shock unresponsive to treatment and died
• The authors' conclusion: The authors concluded that, with no evidence-based guidelines available, early detection and surgical removal remain the most successful therapy, but this is seldom achieved because of the tumor's local aggressiveness.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Malignant Mesothelioma, Prognosis, Dyspnea, Pleural Effusion, Sarcomatoid, Asbestos Exposure, Neoplasm.

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• Hamartoma of mature cardiomyocytes in right atrium: A case report and literature review — X. Zhou, Y. Zhou, et al. (2019)
• Primary epithelial tumour in the right atrium of the heart and inferior vena cava in NZR/gd inbred rats; pathology of 18 cases — C.M. Goodall, G.S. Christie, et al. (1975)
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• Sarcomatous tumor of the chest wall with osteochondroid differentiation. Evidence of mesothelial origin — A. Andrion, G. Mazzucco, et al. (1989)

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