Endobronchial ultrasound-guided transbronchial needle aspiration in a patient with pericardial mesothelioma

Our plain-English summary of Endobronchial ultrasound-guided transbronchial needle aspiration in a patient with pericardial mesothelioma, by H. Ashinuma, M. Shingyoji, Y. Yoshida, et al (Internal Medicine, 2015).

The study

• Authors: H. Ashinuma, M. Shingyoji, Y. Yoshida, M. Itakura, F. Ishibashi, H. Tamura, Y. Moriya, M. Itami, K. Tatsumi, T. Iizasa
• Journal: Internal Medicine
• Published: 2015;54(1):43-8
• Type of article: Case report
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pericardial mesothelioma is a very rare pericardial tumor. Diagnosing pericardial disease can be challenging, and obtaining an antemortem diagnosis of pericardial mesothelioma is particularly difficult. We herein report the case of a 60-year-old man with pericardial mesothelioma diagnosed on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Chest computed tomography showed a mass surrounding the pericardium, and EBUS-TBNA of the right inferior paratracheal and subcarinal stations was consequently performed. No uptake was noted on (18)F-fluorodeoxy glucose positron emission tomography, other than in the pericardial mass. The results of histological and immunohistochemical examinations indicated the features of malignant mesothelioma. We therefore diagnosed the patient with pericardial mesothelioma, which was subsequently confirmed at autopsy.

In plain English

This article is a case report about one patient, a 60-year-old man treated at a hospital in Japan, who had pericardial mesothelioma, a cancer of the lining around the heart. He was admitted with breathlessness on exertion and swelling of the legs. A CT scan showed a mass surrounding the heart and fluid around both lungs. A PET scan showed abnormal activity in the mass around the heart but not in the pleura or other organs. Doctors took samples from two lymph node areas in the chest with a needle passed through the airway under ultrasound guidance (EBUS-TBNA). Tissue staining of these samples suggested pericardial mesothelioma. His heart failure worsened quickly, he received no chemotherapy, and he died two weeks after admission. At autopsy the space around the heart was completely filled with tumor, there was no pleural or peritoneal involvement, and no asbestos bodies were found. The authors reported that he had no history of asbestos exposure. They described this as the first reported case diagnosed with EBUS-TBNA and suggested the method may become a useful diagnostic tool.

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 60-year-old man admitted with breathlessness on exertion and leg swelling to the authors' hospital (affiliations: Chiba Cancer Center, Japan); dates not given
• Exposure: No asbestos exposure: the authors reported no history of asbestos exposure, and no asbestos bodies were found at autopsy
• Main results:
  • Chest CT showed a mass surrounding the epicardium (the outer surface of the heart), along with fluid around both lungs
  • FDG-PET showed abnormal uptake in the mass around the heart, with no abnormal uptake in the pleura or other organs
  • Tissue from EBUS-TBNA stained positive for pan-cytokeratin, calretinin and WT-1 and negative for TTF-1 and surfactant protein A, which suggested pericardial mesothelioma
  • The patient's heart failure worsened rapidly, chemotherapy was not given, and he died two weeks after admission from obstructive shock
  • At autopsy the pericardial cavity was completely occupied by tumor, with no pleural or peritoneal involvement
  • No asbestos bodies were found at autopsy
• The authors' conclusion: The authors described this as the first reported case of pericardial mesothelioma diagnosed using EBUS-TBNA and suggested EBUS-TBNA may become a useful tool for diagnosing primary pericardial mesothelioma
• Limitations the authors state:
  • The authors noted that EBUS-TBNA instruments can reach only some parts of the mediastinum

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: Ultrasound, Pericardial Mesothelioma, Pericardial, Pericardium, Malignant Mesothelioma, Autopsy.

Related studies

• "Dry" pleural mesothelioma successfully diagnosed on endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) — F. Lococo, G. Rossi, et al. (2014)
• Diagnostic usefulness of endobronchial ultrasound-guided transbronchial needle aspiration in a case with malignant pleural mesothelioma — J. Hamamoto, D. Notsute, et al. (2010)
• The role of endobronchial ultrasound guided transbronchial needle aspiration cytology in the investigation of mediastinal lymphadenopathy and masses, the North Tees experience — S. Natu, J. Hoffman, et al. (2010)
• Endobronchial ultrasound-guided transbronchial needle aspiration with the flexible 19-gauge needle — R. Trisolini, F. Natali, et al. (2018)
• Endoscopic ultrasound-guided fine needle aspiration of a pericardial mass — P. Somani, M. Sharma, et al. (2016)
• The role of endobronchial ultrasound-guided fine needle aspiration in the diagnosis of pleural mesothelioma — M.R. Ghigna, A. Crutu, et al. (2016)

Browse more research in Internal Medicine, or return to medical research.