Malignant pericardial mesothelioma : A systematic review of current practice

Our plain-English summary of Malignant pericardial mesothelioma : A systematic review of current practice, by S. Cao, S. Jin, J. Cao, et al (Herz, 2018).

The study

• Authors: S. Cao, S. Jin, J. Cao, J. Shen, H. Zhang, Q. Meng, B. Pan, Y. Yu
• Journal: Herz
• Published: 2018;43(1):61-68
• Type of article: Systematic review
• Cited by: 32 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant mesothelioma is a rare but aggressive tumor, with a high misdiagnosis rate and overall bleak prognosis. In 0.7% of all cases, the origin is the pericardium.

Methods: The present study is a review of the literature published in recent decades focusing on the advances in clinical manifestations, radiological findings, diagnosis, differential diagnosis, and treatment of malignant pericardial mesothelioma (MPM).

Results: No clear relationship has been established between the etiologies and the development of MPM. Clinical symptoms and signs are nonspecific when present. The main presentations are chest pain and dyspnea. Imaging plays an important role in the detection, characterization, staging, and posttreatment follow-up. The definitive diagnosis is made on the basis of pathological findings. Chest radiography and echocardiography are common techniques used initially, but their roles are limited. Computed tomography and magnetic resonance imaging have an advantage in depicting the thickened pericardium, mediastinal lymph node, tumor, and the extension of adjacent structures. Surgery is the most important treatment modality and remains palliative in most cases, while the roles of chemo- and radiotherapy are unsatisfactory.

Conclusion: Clinical trials of malignant pleural and peritoneal mesothelioma remain important for MPM management. Multimodality treatment of surgery, chemotherapy, radiotherapy, and immunotherapy is expected to have a role in the treatment of MPM.

In plain English

This article is a literature review of published reports on malignant pericardial mesothelioma, a cancer of the lining around the heart. About 200 cases have been reported worldwide, mostly as case reports or small case series. Although titled a systematic review, the text does not describe how the literature was searched. The authors wrote that, unlike in pleural and peritoneal mesothelioma, the role of asbestos in pericardial mesothelioma is controversial, with no clear link established. They tabulated two earlier reviews that covered 30 and 28 cases. Exposure was not mentioned for 16 cases in each review, and among the rest, asbestos exposure was reported in 3 of 14 and 4 of 12. Another study found occupational asbestos exposure in 5 of 7 patients. Other possible risk factors cited were SV40 infection, irradiation, thorotrast, tuberculosis and erionite. Cited sources put median survival at 6 months from first symptoms, with diagnosis made before death in about 30% of cases. The authors concluded that no standard treatment exists and clinical trials are urgently needed. They added that long-term survival can be expected when a localized tumor is completely removed.

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 literature review. It is titled a systematic review, but the text describes no search or selection method.
• Who was studied: Published cases of malignant pericardial mesothelioma: about 200 reported worldwide, mostly in case reports or small case series.
• Exposure: Asbestos exposure was discussed as a possible cause. SV40 infection, irradiation, thorotrast, tuberculosis and erionite were also cited as possible risk factors.
• Main results:
  • The authors wrote that, unlike in pleural and peritoneal mesothelioma, the role of asbestos in pericardial mesothelioma is controversial and no clear correlation has been established.
  • Table 1 covers two earlier literature reviews of 30 and 28 cases. Exposure was not mentioned for 16 of 30 and 16 of 28 cases. Among cases with exposure status recorded, asbestos exposure was reported in 3 of 14 (21%) and 4 of 12 (33%), and no known exposure in 11 of 14 (79%) and 8 of 12 (67%).
  • One cited study found occupational asbestos exposure in 71.4% of pericardial mesothelioma patients (5 of 7 cases).
  • Citing an earlier source, the authors reported a median survival of 6 months from the first symptoms.
  • Citing an earlier source, the authors reported that the diagnosis was made before the patient's death in only about 30% of cases.
  • Table 3 lists eight patients with localized tumors. One case was found at autopsy and one patient died 3 days after surgery. Overall survival for the remaining patients, who received surgery and adjuvant therapies, ranged from 3 months to 28 years.
  • Pemetrexed with platinum chemotherapy had been applied in several reported cases. The results were not as impressive as in pleural and peritoneal mesothelioma.
• The authors' conclusion: The authors concluded that no standard treatment strategy has been established and that clinical trials are urgently needed. They also concluded that long-term survival can be expected in patients with a localized tumor and complete resection.
• Limitations the authors state:
  • The authors stated that the rarity of the disease and uncertainty in diagnosing it limit understanding of its natural history.

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: Pericardial Mesothelioma, Systematic Review, Malignant Mesothelioma, Misdiagnosis, Prognosis, Pericardium, Differential Diagnosis, Dyspnea.

Related studies

• Malignant pericardial mesothelioma. Report of two cases, review of the literature and differential diagnosis — M. Papi, G. Genestreti, et al. (2005)
• 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)
• Pericardial synovial sarcoma, a potential for misdiagnosis: clinicopathologic and molecular cytogenetic analysis of three cases with literature review — Y. Cheng, W. Sheng, et al. (2012)
• Pericardial malignant mesothelioma: a latent complication of radiotherapy? — G.R. Small, M. Nicolson, et al. (2008)
• 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)

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