Case Report: Early diagnosis and bevacizumab-based chemotherapy for primary pericardial mesothelioma: a case with occupational asbestos exposure history

Our plain-English summary of Case Report: Early diagnosis and bevacizumab-based chemotherapy for primary pericardial mesothelioma: a case with occupational asbestos exposure history, by D. Wang, Y.H. Wang, S.C. Chu (Frontiers in Cardiovascular Medicine, 2023).

The study

• Authors: D. Wang, Y.H. Wang, S.C. Chu
• Journal: Frontiers in Cardiovascular Medicine
• Published: 2023;10:1257373
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Primary pericardial mesothelioma (PPM) is an exceedingly rare malignant cancer and has a poor prognosis, which has been partly attributed to its frequently delayed diagnosis due to its nonspecific syndromes, its similar presentation to benign pericardial diseases, and its non-definitive etiology. In many PPM cases, the time from presentation to definite diagnosis may last for several months or even over one year. Unlike pleural mesothelioma, the relationship between PPM and asbestos exposure remains unsettled. To date, there is no consensus on the treatment of PPM.

Case Report: The patient is a 57-year-old male who had nonspecific syndromes and inconclusive image findings. The occupational long-term asbestos exposure history of this patient raised our concerns regarding potential malignancy when confronted with unexplained pericardial effusion accompanied by cardiac tamponade. The heightened suspicion prompted us to perform pericardiocentesis and biopsy on the third day after admission to our department. An early diagnosis of PPM was established by the pathological and immunohistochemical evaluation of the biopsy specimen two weeks after admission. Positron emission tomography-computed tomography revealed that the lesion was localized at the anterior part of the mediastinum without distant metastasis. This patient refused to receive cardiac surgery. He subsequently underwent six cycles of chemotherapy (cisplatin plus pemetrexed) in combination with bevacizumab (a humanized anti-VEGF antibody) as the first-line treatment, resulting in complete relief of symptoms and satisfactory outcomes with no complications. Four months after the first course, the patient initiated a second course of chemotherapy with a similar regimen, but he opted to discontinue the medical treatment after the initiation of the second course. The patient was transferred to the hospice care unit and unfortunately expired one year after the initial presentation.

Conclusion: We present a case of an early multidisciplinary clinical approach to diagnose and manage PPM with consideration of occupational asbestos exposure history and clinical symptoms. Bevacizumab-based chemotherapy remains an option for the treatment of PPM.

© 2023 Wang, Wang and Chu.

In plain English

This case report described one patient: a 57-year-old man admitted to the authors' hospital department in Taiwan on 18 July 2022 with chest tightness, dry cough, breathlessness and weight loss. He had a 20-year history of occupational asbestos exposure as an interior designer, working with sound and heat insulation material that contained high levels of asbestos. The article did not name the fiber type. Fluid around his heart was drained on Day 1, and a pericardial biopsy was taken on Day 3. Tissue tests and a PET-CT scan, which showed no distant spread, led to a diagnosis of primary pericardial mesothelioma on Day 11. He declined surgery. He received six cycles of bevacizumab, cisplatin and pemetrexed. Afterwards his scans showed normal heart size and no fluid around the heart or lungs. He began a second course on Day 270 but stopped it because of side effects. He died in hospice care on Day 355. The authors concluded that bevacizumab-based chemotherapy remains an option for this cancer. They also stated that the early detection in this case supports the notion that asbestos exposure plays a role in its development.

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 (one patient)
• Who was studied: One 57-year-old male patient admitted to the authors' department on 18 July 2022. The authors are based at Hualien Tzu Chi Hospital and Tzu Chi University, Hualien, Taiwan. He was an active smoker.
• Exposure: 20 years of occupational asbestos exposure as an interior designer, with frequent contact with sound and heat insulation material containing high levels of asbestos, without consistent use of a face mask. The fiber type was not stated.
• Main results:
  • Pericardiocentesis (draining fluid from around the heart) was performed on Day 1 for unexplained pericardial effusion, and the drained fluid was purulent and bloody.
  • In the pericardial biopsy, tumor cells stained positive for cytokeratin 5/6, retained BRCA1-associated protein 1, and had lost methylthioadenosine phosphorylase.
  • PET-CT showed fluorodeoxyglucose uptake in the anterior mediastinum (the front of the chest) with no metastasis.
  • The diagnosis of primary pericardial mesothelioma was made on Day 11 after admission.
  • The patient declined surgery. Cycles 1 to 6 used bevacizumab 5 mg/kg, cisplatin 50 to 60 mg/m2 and pemetrexed 400 to 500 mg/m2.
  • The patient tolerated the first cycle well, with mild appetite loss and nausea.
  • After 6 cycles (Day 149), chest x-ray and CT showed normal heart size, no pleural or pericardial effusion, and lessened pericardial thickening.
  • A second course of chemotherapy started on Day 270. The patient discontinued it because of side effects.
  • The patient was transferred to hospice care and died on Day 355.
  • The authors stated that their finding on early detection supports the notion that asbestos exposure plays a role in causing primary pericardial mesothelioma.
• The authors' conclusion: The authors concluded that, although the patient died after stopping the second course of chemotherapy by his own decision, bevacizumab-based chemotherapy remains an option for treating primary pericardial mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Bevacizumab, Chemotherapy, Pericardial Mesothelioma, Asbestos Exposure, Prognosis, Pericardial, Etiology, Pleural Mesothelioma.

Related studies

• Timely diagnosis of primary pericardial mesothelioma — H.C. Chen, S. Chang, et al. (2020)
• Detailed occupational history: the cornerstone in diagnosis of asbestos-related lung disease — R. Bégin, J.W. Christman (2001)
• Pemetrexed Maintenance Therapy Following Bevacizumab-Containing First-Line Chemotherapy in Advanced Malignant Pleural Mesothelioma: A Case Report and Literatures Review — X.Q. Jing, L. Zhou, et al. (2016)
• Surgical pathology of primary cardiac and pericardial tumors — C. Basso, M. Valente, et al. (1997)
• Primary pericardial tumors — C.S. Restrepo, D. Vargas, et al. (2013)
• Primary pericardial mesothelioma: report of two cases and review of the literature — A.L. Sytman, R.N. MacAlpin (1971)

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