Post-irradiation pericardial malignant mesothelioma: an autopsy case and review of the literature

Our plain-English summary of Post-irradiation pericardial malignant mesothelioma: an autopsy case and review of the literature, by M. Bendek, M. Ferenc, N. Freudenberg (Cardiovascular Pathology, 2010).

The study

• Authors: M. Bendek, M. Ferenc, N. Freudenberg
• Journal: Cardiovascular Pathology
• Published: 2010;19(6):377-9
• Type of article: Case report, Review
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report a case of a malignant pericardial mesothelioma of the epithelioid type in a 39-year-old man. He had a history of nodular sclerosing Hodgkin's disease treated with irradiation of the cervical and mediastinal regions 24 years before, and of infarction of the anterior wall of the left ventricle, after which a percutaneous coronary intervention was carried out 7 years previously. He was admitted to a cardiology unit with progressive dyspnea. On examination, a hemorrhagic pericardial fluid collection of 600 ml was detected which was successfully drained. On the next day, the patient developed an electromechanical dissociation suggesting a pericardial tamponade, which was followed by circulatory arrest. At autopsy, the pericardial sac was found to contain 300 ml of partly clotted blood. The epicardial surface showed a diffuse thickening, suggesting a chronic fibrous pericarditis without a macroscopically evident distinct tumor mass. A rupture measuring 0.4 cm in diameter was detected in the right ventricular free wall, 1 cm below the level of the tricuspid valve. The diagnosis of a diffusely growing, malignant mesothelioma of the epithelioid type was made on the basis of histological and immunohistochemical examination of the thickened pericardium.

Copyright © 2010 Elsevier Inc. All rights reserved.

In plain English

This article was a case report of one patient, followed by a short discussion of earlier published cases. The authors described a 39-year-old man who was admitted to a cardiology unit with breathlessness that had been getting worse for 3 weeks. Twenty-four years earlier, at age 15, he had received radiation therapy to the neck and upper chest lymph node regions for Hodgkin's disease. Doctors drained 600 ml of bloody fluid from around his heart. The next day he developed electromechanical dissociation and circulatory arrest, and he died. At autopsy, the sac around the heart held 300 ml of partly clotted blood, which had passed through a 0.4 cm rupture in the wall of the right ventricle. No distinct tumor mass was visible to the eye. Microscopic and immunohistochemical tests showed epithelioid malignant mesothelioma of the pericardium, the lining around the heart. The article does not say whether the man had any asbestos exposure. The authors described this as the third reported case of pericardial mesothelioma after radiation therapy. They concluded that, although very rare, it should be considered in previously irradiated patients who develop fluid around the heart.

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: Autopsy case report of a single patient, with a brief discussion of previously published cases
• Who was studied: One 39-year-old man admitted to a cardiology unit; the pathological examinations were done at the Institute of Pathology, Universitätsklinikum Freiburg, Germany
• Exposure: Mantle field radiation therapy to the upper mediastinal and cervical lymph node regions for nodular sclerosing Hodgkin's disease at age 15, 24 years before death. The dose is printed as "6×44 Gy". The article does not report on asbestos exposure for this patient.
• Main results:
  • On admission, 600 ml of bloody fluid around the heart (pericardial fluid) was found and drained
  • The patient developed electromechanical dissociation and circulatory arrest and died
  • At autopsy, the pericardial cavity contained 300 ml of partly clotted blood, which had passed through a 0.4 cm rupture in the right ventricular wall
  • No distinct tumor mass was visible to the eye; the heart surface looked like chronic fibrous pericarditis
  • Under the microscope, tumor cells had invaded the heart muscle at the site of the rupture
  • Tumor cells stained positive for calretinin, cytokeratins 5 and 6, cytokeratin 7, D2-40 and focally vimentin, supporting a diagnosis of epithelioid malignant mesothelioma
  • The authors stated this was the third reported case of post-irradiation malignant pericardial mesothelioma
  • The patient also had severe coronary artery disease and an old heart attack (infarction). The authors suggested that his young age at the time of the infarction, 33 years, pointed to a role for the chest irradiation, although other risk factors were also present.
• The authors' conclusion: The authors concluded that, although very rare, pericardial malignant mesothelioma should be considered in patients with a prior history of irradiation who present with pericardial effusion

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, Autopsy, Pericardial Mesothelioma, Epithelioid, Dyspnea, Pericardium.

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• Unexpected malignant pericardial mesothelioma presenting as pericardial constriction — M. Oc, B. Oc, et al. (2012)

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