Malignant mesothelioma of the pericardium: case reports and immunohistochemical studies including Ki-67 expression

Our plain-English summary of Malignant mesothelioma of the pericardium: case reports and immunohistochemical studies including Ki-67 expression, by H. Hirano, T. Maeda, M. Tsuji, et al (Pathology International, 2002).

The study

• Authors: H. Hirano, T. Maeda, M. Tsuji, Y. Ito, T. Kizaki, Y. Yoshii, T. Sashikata
• Journal: Pathology International
• Published: 2002;52(10):669-76
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pericardial malignant mesothelioma (PMM) is extremely rare compared with pleural cases of mesothelioma. We present the clinical and pathological features of three autopsy cases with PMM. All three cases showed rapid progress and died of heart failure. Detailed examination was obtained from the autopsy. Macroscopic appearances of each case showed a thickened pericardium due to tumor invasion. Microscopic observations of all cases led to a diagnosis of epithelial-type malignant mesothelioma (MM). The results of immunohistochemical examinations were similar to the previous published work on pleural mesothelioma. To disclose the pathological characteristics of PMM, we analyzed Ki-67 labeling index (LI) of three cases of PMM and five cases of pleural MM that died within 2 years. The difference of Ki-67 LI between PMM and pleural MM was not significant (P > 0.05). The poor prognosis of patients with PMM must be caused by restricted cardiac wall motion due to tumor involvement, in addition to the tumor proliferation itself.

In plain English

This case report described three men in Japan, aged 26, 40 and 58, who died of malignant mesothelioma of the pericardium (the sac around the heart) and were examined at autopsy. Two died of heart failure and one of cardiac tamponade, all within a year. Two men had no history of asbestos exposure, the third man's history was unknown, and no asbestos bodies were found in any of their lungs. All three tumors were of the epithelial type. Laboratory staining found calretinin, vimentin and thrombomodulin in all three tumors. The authors also measured Ki-67, a marker of how quickly tumor cells divide. It was 14.7 percent (plus or minus 1.9) in the three pericardial cases and 16.8 percent (plus or minus 6.8) in five pleural mesothelioma cases whose patients died within 2 years. The difference was not statistically significant. The authors concluded that their cases did not suggest asbestos played a part. They also concluded that the poor outlook in pericardial mesothelioma comes not only from tumor growth but also from the tumor restricting the heart's movement.

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 of three autopsy cases, with immunohistochemical studies and a Ki-67 comparison against pleural mesothelioma cases
• Who was studied: Three men (aged 26, 40 and 58) with pericardial malignant mesothelioma, seen at hospitals in the Osaka and Hyogo areas of Japan; for comparison, five cases of epithelial-type pleural malignant mesothelioma in patients who died within 2 years of diagnosis
• Exposure: Cases 1 and 2 had no history of asbestos exposure. Case 3's history was unknown. Asbestos bodies were not found in the lungs of any of the three patients.
• Main results:
  • All three pericardial cases were diagnosed as epithelial-type malignant mesothelioma.
  • All three patients died within 1 year: case 1 after 11 months, case 2 after 2 months (of cardiac tamponade), and case 3 after 7 months (of heart failure).
  • Ki-67 labeling index: 14.7 plus or minus 1.9 percent in the three pericardial cases, and 16.8 plus or minus 6.8 percent in the five pleural cases.
  • The difference in Ki-67 labeling index between the pericardial and pleural cases was not statistically significant (P greater than 0.05, t-test).
  • In the three pericardial cases, vimentin was positive in all three tumors, cytokeratin in two of three, and calretinin and thrombomodulin in all three.
  • Weak carcinoembryonic antigen (CEA) staining was seen only in case 1 of the three pericardial cases.
  • Of the three pericardial cases, distant metastasis was seen only in case 2.
• The authors' conclusion: The authors concluded that the poor prognosis of pericardial mesothelioma is due both to tumor proliferation and to restricted heart wall motion from tumor invasion around the heart. They also concluded that their cases did not suggest asbestos involvement.
• Limitations the authors state:
  • The tissue came from autopsies and had been fixed in formalin for a long time, so antigenicity may have decreased. The authors offered this as a possible reason some markers were negative.
  • Electron microscopy could not be done for cases 2 and 3 because of marked postmortem changes.
  • Two cases did not meet all of Anderson and Hansen's criteria for primary pericardial mesothelioma.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Pericardium, Ki-67, Pericardial, Mesothelioma, Autopsy, Pleural Mesothelioma, Prognosis.

Related studies

• Malignant mesothelioma of the peritoneum: case reports and immunohistochemical findings including Ki-67 expression — H. Hirano, T. Fujisawa, et al. (2010)
• Primary malignant mesothelioma of the pericardium — J. Patel, M.N. Sheppard (2011)
• Primary sarcomatoid malignant mesothelioma of the pericardium — T. Terada (2012)
• 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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