Pericardial malignant mesothelioma: a latent complication of radiotherapy?

Our plain-English summary of Pericardial malignant mesothelioma: a latent complication of radiotherapy?, by G.R. Small, M. Nicolson, K. Buchan, et al (European Journal of Cardio-thoracic Surgery, 2008).

The study

• Authors: G.R. Small, M. Nicolson, K. Buchan, P. Broadhurst
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2008;33(4):745-7
• Type of article: Case report
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pericardial diseases can be difficult to differentiate from myocardial conditions. Diagnosis can be challenging and often requires the use of different imaging modalities. Here, we describe a case which presented with common cardiac symptoms which were shown to be the result of a rare condition. A 62-year-old lady presented with left femoral artery embolism. Post-embolectomy she developed cardiac failure. Three months previously an acellular, sterile pericardial effusion had been drained. In 1993 a left mastectomy and axillary node clearance was performed for breast cancer. Adjuvant chemotherapy and radiotherapy were administered. Examination revealed a raised jugular venous pressure (JVP) with rapid Y descent and Kussmaul's sign. CT chest and abdomen found no recurrence of breast carcinoma. Cardiac MRI demonstrated thickened pericardium. At cardiac catheterisation haemodynamic responses consistent with constrictive pericarditis were seen. Pericardiectomy was performed. Histology revealed pericardial epithelioid malignant mesothelioma. 18-FDG-PET CT post-operatively was negative in the pericardium and pleura. Chemotherapy with pemetrexed and carboplatin was given. The patient died 9 months after presentation. Radiotherapy and asbestos exposure are both associated with pericardial mesothelioma and the aetiology in this case was not clear. The condition carries a poor prognosis and is invariable fatal although newer chemotherapeutic regimens have prolonged survival times.

In plain English

This case report described a 62-year-old woman, a non-smoker, who had been treated in 1993 for breast cancer with a left mastectomy, chemotherapy and radiotherapy. She arrived at hospital with atrial fibrillation and a blocked leg artery, then developed fluid on the lungs. Heart scans and cardiac catheterisation showed a thickened pericardium (the sac around the heart) and findings consistent with constrictive pericarditis. Surgeons removed the pericardium, believing radiotherapy had caused the problem. Tissue examination instead showed epithelioid malignant mesothelioma of the pericardium. A PET-CT scan after surgery was negative in the pericardium and pleura. She received pemetrexed and carboplatin, worsened after the first cycle, chose palliative care, and died nine months after presentation. The authors suggested the tumour may still be attributable to radiotherapy. They noted this link is less certain because the disease is more common in men. Her husband was a car mechanic. The authors said unrecognised asbestos exposure through his work was possible. They also said the localised disease without pleural involvement argued against inhaled asbestos.

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
• Who was studied: One 62-year-old woman, a non-smoker, treated at Aberdeen hospitals in Scotland (authors' affiliations); year of presentation not stated
• Exposure: Radiotherapy and chemotherapy after left mastectomy for breast cancer in 1993. The authors also raised possible unrecognised asbestos exposure through her husband's work as a car mechanic (clutch linings and brake materials). No asbestos fibre analysis of her tissue was reported.
• Main results:
  • Cardiac MRI showed a thickened, lobulated pericardium, and catheterisation confirmed features of constrictive pericarditis
  • Tissue removed at pericardiectomy showed pericardial epithelioid malignant mesothelioma
  • Post-operative 18-FDG-PET CT was negative in the pericardium and pleura
  • After chemotherapy with pemetrexed and carboplatin she deteriorated, moved to palliative care, and died nine months after presentation
  • The patient was the wife of a car mechanic. The authors said she may have had unrecognised asbestos exposure through his occupation, though whether such exposure increases mesothelioma risk is debated.
  • The authors said the absence of pleural disease and the localised nature of the tumour would argue against previous inhalation exposure to asbestos
• The authors' conclusion: The authors concluded that the unexpected pericardial epithelioid mesothelioma may still be attributable to radiotherapy, while asbestos exposure via her spouse's work could not be excluded
• Limitations the authors state:
  • The authors stated the link between pericardial mesothelioma and radiotherapy is less certain because the condition shows a 2:1 male preponderance, despite breast cancer and its radiotherapy mostly affecting women
  • The authors stated that histology in pericardial disease is usually unhelpful for clarifying cause, for example by identifying asbestos fibres

Topics

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

Medical terms in this study, explained in our Lexicon: Pericardial, Malignant Mesothelioma, Pericardial Effusion, Chemotherapy, Carcinoma, Pericardium, Pericardiectomy, Histology.

Related studies

• Post-irradiation pericardial malignant mesothelioma: an autopsy case and review of the literature — M. Bendek, M. Ferenc, et al. (2010)
• 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)
• Pericardial mesothelioma presenting as left atrial thrombus in a patient with mitral stenosis — Y. Miyamoto, S. Nakano, et al. (1996)
• Neoplastic Pericardial Disease — J.J. Maleszewski, N.S. Anavekar (2017)
• An autopsy case of a malignant pericardial mesothelioma in a Japanese young man — M. Watanabe, H. Suzuki, et al. (1999)
• Primary sarcomatoid malignant pericardial mesothelioma — D. Jiang, M. Kong, et al. (2013)

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