Multicystic mesothelioma of the pericardium

Our plain-English summary of Multicystic mesothelioma of the pericardium, by S. Morita, A. Goto, T. Sakatani, et al (Pathology International, 2011).

The study

• Authors: S. Morita, A. Goto, T. Sakatani, S. Ota, T. Murakawa, J. Nakajima, E. Maeda, M. Fukayama
• Journal: Pathology International
• Published: 2011;61(5):319-21
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Multicystic mesothelioma is a well recognized but rare serosal tumor which mainly arises from the peritoneum in women and is considered as a benign lesion. This is the second case report of pericardial multicystic mesothelioma, which took a fatal clinical course. A 63-year-old man presented with pitting edema, shortness of breath, and hoarseness. Radiological investigations revealed solid and cystic tumor of the pericardium which was continuously extending into the mediastinum and the liver. Pericardial biopsy showed micro-cystic tumor lined by single layer of mesothelial cells without atypia, and the diagnosis was multicystic mesothelioma. Curative surgery could not be performed, and three years and four months later, the patient died because of the direct compression of the heart by the tumor. At autopsy, the tumor was found to be directly extending into the right pleural cavity and the right lung, besides the mediastinum and the liver. Neither malignant transformation nor metastatic tumor was identified.

© 2011 The Authors. Pathology International © 2011 Japanese Society of Pathology and Blackwell Publishing Asia Pty Ltd.

In plain English

This was a case report from the University of Tokyo about one man with multicystic mesothelioma of the pericardium, the sac around the heart. The authors described this as a rare tumor that mainly arises in the peritoneum of women and is generally considered benign. The man had no history of asbestos inhalation. He was first seen at age 62 at another hospital, where a needle biopsy did not give a diagnosis. Two years later he was admitted to the University of Tokyo Hospital. Scans showed a solid and cystic tumor around the heart extending into the mediastinum and liver. A pericardial biopsy showed tiny cysts lined by a single layer of mesothelial-like cells without significant atypia. The tumor could not be removed by surgery. He died three years and four months after that admission. At autopsy the tumor had grown directly into the heart muscle, right chest cavity, right lung and liver. No malignant transformation and no asbestos bodies were found. The authors concluded that the term 'benign multicystic mesothelioma' should be avoided.

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 a single patient, including biopsy, CT scans, postmortem CT and autopsy findings
• Who was studied: One man, aged 62 when first admitted to a nearby hospital, later treated at The University of Tokyo Hospital, Japan
• Exposure: No asbestos exposure was reported. The patient had no history of asbestos inhalation, and no asbestos bodies were found at autopsy.
• Main results:
  • CT on admission showed a solid and cystic tumor surrounding the heart and extending into the upper mediastinum and the liver
  • The pericardial biopsy showed a micro-cystic tumor lined by a single layer of mesothelial-like cells without significant atypia. There was no abnormal p53 accumulation, and the Ki-67 labeling index was 5 to 6%. The findings were consistent with multicystic mesothelioma.
  • Curative surgery could not be performed because the lesion filled the pericardial cavity and was strongly stuck to surrounding structures
  • The patient died three years and four months after first admission to the University of Tokyo Hospital. His decline was due to compression of the heart by the tumor and pneumonia. The tumor had been stable after chemotherapy with gemcitabine.
  • At autopsy the tumor extended into the myocardium, mediastinum, right pleural cavity, right lung, liver and nearby lymph nodes. This spread was considered direct extension rather than metastases, and no malignant transformation was found.
• The authors' conclusion: The authors concluded that it would be safe to avoid the term 'benign multicystic mesothelioma', because clinically benign behavior is not guaranteed. They considered it reasonable to regard multicystic mesothelioma as a lesion of intermediate malignancy between adenomatoid tumor and diffuse mesothelioma. They noted that this case's Ki-67 index supports that view.

Topics

Medical terms in this study, explained in our Lexicon: Multicystic Mesothelioma (MCM), Pericardium, Peritoneum, Pericardial, Mediastinum, Biopsy, Mesothelial Cells, Autopsy.

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