Malignancies involving the pericardium

Our plain-English summary of Malignancies involving the pericardium, by W.H. Warren (Seminars in Thoracic and Cardiovascular Surgery, 2000).

The study

• Author: W.H. Warren
• Journal: Seminars in Thoracic and Cardiovascular Surgery
• Published: 2000;12(2):119-29
• Type of article: Review
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignancies rarely arise from the pericardium. Mesothelioma, the most common of these, is usually unresectable and almost always incurable. Malignancies may secondarily involve the pericardium by direct extension. Carcinoma of the lung and malignant thymoma with limited direct invasion of the pericardium both can undergo complete and potentially curative resections, but adjuvant therapy is usually indicated. More frequently, malignancies involve the pericardium by a process of retrograde lymphangitic spread or hematogenous dissemination. These patients present with a symptomatic pericardial effusion and occasionally pericardial tamponade. Subxiphoid pericardiostomy and drainage is a safe procedure that provides effective and durable symptomatic relief in these terminally ill patients. More aggressive open procedures should be reserved for loculated or recurrent pericardial effusions.

In plain English

This article was a narrative review by a thoracic surgeon of cancers that involve the pericardium, the sac around the heart. It reported no new study of patients. The author wrote that malignant mesothelioma was the most common cancer arising from the pericardium itself. For many years this cancer was believed not to be related to asbestos exposure. The author stated, however, that animal studies and human case reports suggest asbestos exposure must, at least in some cases, be considered a significant risk factor for primary pericardial mesothelioma. The author described pericardial mesothelioma as often causing diffuse thickening of the pericardium with little or no fluid. Most such tumors were sarcomatoid rather than epithelioid, the reverse of pleural mesothelioma, and the tumor was described as almost uniformly fatal within 1 year. Most of the review covered other cancers that spread to the pericardium and the treatment of fluid around the heart. It cited a study by Allen et al comparing surgical and needle-catheter drainage. The author concluded that cancer involving the pericardium almost always represents a terminal condition, and that subxiphoid drainage can usually relieve symptoms safely.

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: Narrative review (no original patient data)
• Who was studied: No study population; the author reviewed published literature on malignancies involving the pericardium, including pericardial mesothelioma
• Exposure: Asbestos exposure was discussed as a possible risk factor for primary pericardial mesothelioma, based on animal studies and human case reports; no fiber types were named in the text
• Main results:
  • The author reported that for many years pericardial mesothelioma was believed not to be related to asbestos exposure, in part because many cases had no identifiable exposure and many occurred in childhood
  • Pericardial mesothelioma often presents with little or no effusion but with diffuse thickening of the pericardium
  • Most primary pericardial mesotheliomas are sarcomatoid rather than epithelioid or mixed, the reverse of pleural mesotheliomas
  • Despite surgical debulking, chemotherapy and radiotherapy, pericardial mesothelioma is almost uniformly fatal within 1 year
  • In a cited study by Allen et al, the complication rate was 1.1% with subxiphoid pericardiostomy versus 17% with percutaneous drainage. That study had no operative deaths in 94 open-technique patients and 1 operative death in 23 percutaneous-technique patients.
  • Most patients presenting with a symptomatic malignant pericardial effusion die within 6 months, from advanced disease unrelated to the pericardial involvement
• The authors' conclusion: The author concluded that malignancy involving the pericardium almost always represents a terminal condition. Symptoms can be palliated, and in most cases subxiphoid pericardiotomy and drainage can be performed safely with effective and durable relief.
• Limitations the authors state:
  • The author noted that most published studies on sclerosing agents are based on fewer than 25 patients, and only a few are randomized

Topics

Medical terms in this study, explained in our Lexicon: Pericardium, Mesothelioma, Unresectable, Carcinoma, Adjuvant Therapy, Pericardial Effusion, Pericardial.

Related studies

• Primary malignant mesothelioma of the pericardium — J. Patel, M.N. Sheppard (2011)
• Letter: Mesothelioma of the pericardium with cholesterol pericarditis — E. Argianas, K. Melissinos, et al. (1974)
• A second case of pericardial mesothelioma mimicking systemic lupus erythematosus in the literature in over 30 years: a case report — C. Mensi, A. Romano, et al. (2017)
• Primary tumors and cysts of the heart and pericardium — H.A. McAllister (1979)
• Primary malignant mesothelioma of the pericardium. Case report and literature review — R. Thomason, W. Schlegel, et al. (1994)
• Malignant mesothelioma arising after direct application of asbestos and fiber glass to the pericardium — A. Churg, M.L. Warnock, et al. (1978)

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