Desmoplastic malignant mesothelioma of the pericardium: Description of a case and review of the literature

Our plain-English summary of Desmoplastic malignant mesothelioma of the pericardium: Description of a case and review of the literature, by A. Nicolini, A. Perazzo, S. Lanata (Lung India, 2011).

The study

• Authors: A. Nicolini, A. Perazzo, S. Lanata
• Journal: Lung India
• Published: 2011;28(3):219-21
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Desmoplastic mesothelioma (DMM) is a rare and highly lethal subtype of diffuse malignant mesothelioma and is often difficult to distinguish from reactive pleural fibrosis. The term "desmoplastic" refers to the growth of fibrous or connective tissue. We report the clinical, radiological, and pathological features of a primary DMM of the pericardium and a short review of the literature. A 72-year-old man was admitted presenting shortness of breath, cough, and asthenia. Computed tomography scan showed thickenings and effusions both in the pleura and in the pericardium. Histopathological diagnosis was performed by surgical pericardial biopsy and confirmed by autopsy. The patient had a history of asbestos exposure. Primary mesothelioma of the pericardium is a rare tumor occurring in the fourth to seventh decades with nonspecific symptoms and a rapid clinical course. The diagnosis is difficult and often needing a surgical pericardial biopsy. The prognosis is poor although newer antiblastic drugs seem to prolong survival times.

In plain English

This article reports one patient and adds a short review of earlier published literature. The patient was a 72-year-old man, previously healthy and a lifelong nonsmoker, with a known asbestos exposure. The article does not say what type of asbestos or how he was exposed. He was admitted to hospital after three weeks of shortness of breath, cough and fatigue. Scans showed thickening and fluid in the lining around both lungs (the pleura) and around the heart (the pericardium). Fluid drawn from the chest showed no cancer cells. Surgeons drained the fluid around the heart and took a tissue sample. The authors called the sample difficult to interpret, but the final diagnosis was desmoplastic malignant mesothelioma. His condition worsened, chemotherapy could not be started, and he died 20 days after the operation. An autopsy found a large tumor encasing the heart and major blood vessels, and no tumor in the lungs. In their literature review, the authors wrote that the role of asbestos exposure in this disease is not clear. The authors concluded that diagnosis is very difficult and the outlook extremely poor.

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) with a short review of the literature
• Who was studied: One 72-year-old man, previously healthy and a lifelong nonsmoker, admitted to hospital with a 3-week history of shortness of breath, cough and fatigue. The authors are at the Hospital of Sestri Levante, Genoa, Italy. The date of the case is not given.
• Exposure: Known asbestos exposure. The fiber type, source, job and amount are not described.
• Main results:
  • CT scan of the chest in this patient showed thickening and fluid on both sides in the pleura, together with thickening of the pericardium and fluid all around the heart.
  • Fluid removed from the patient's chest contained no cancer cells, and its hyaluronic acid level was 0.8 mg/ml.
  • The authors described the pericardial biopsy taken at surgery as difficult to interpret and controversial. The final diagnosis was desmoplastic malignant mesothelioma.
  • The patient's condition prevented chemotherapy from being started, and he died 20 days after the heart operation.
  • At autopsy, a large white tumor mass surrounded and encased the heart and the large blood vessels. The tumor infiltrated the heart muscle and the chest wall. No tumor was found in the lungs.
  • On laboratory staining of autopsy tissue, the tumor cells were positive for calretinin, cytokeratin 5/6, WT1, D2-40 and cytokeratin 7, and negative for MOC31.
  • In their review of earlier literature (not this patient), the authors wrote that the role of asbestos exposure in pericardial mesothelioma is not clear, although it has been documented in a few patients.
• The authors' conclusion: The authors concluded that diagnosis of this cancer is very difficult and often incidental, and that the prognosis is extremely poor. They added that newer chemotherapy regimens seem to prolong survival times.

Topics

Medical terms in this study, explained in our Lexicon: Desmoplastic Mesothelioma, Malignant Mesothelioma, Pericardium, Fibrosis, Pleura, Pericardial, Biopsy, Autopsy.

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