Primary malignant mesothelioma of the pericardium

Our plain-English summary of Primary malignant mesothelioma of the pericardium, by J. Patel, M.N. Sheppard (Cardiovascular Pathology, 2011).

The study

• Authors: J. Patel, M.N. Sheppard
• Journal: Cardiovascular Pathology
• Published: 2011;20(2):107-9
• Type of article: Case report
• Cited by: 29 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Primary malignant pericardial mesothelioma is an extremely rare tumor. One of the largest autopsy series gave an incidence of primary pericardial tumors of 0.0022%, of which mesothelioma is the most common type. A male predominance of the disease has been described, and the majority of cases occur in the fourth to seventh decades of life. Unlike peritoneal and pleural mesothelioma, there has been no definite correlation between asbestos exposure and pericardial disease. Malignant pericardial mesothelioma carries a poor prognosis with few successful treatment strategies and little benefit from radiation and chemotherapy. We report a case of a 66-year-old man who presented with shortness of breath, right shoulder pain, and peripheral edema of the lower limbs. A large pericardial effusion was seen on echocardiography, which was drained but the patient died the following day. A malignant tumor was found on autopsy and a final diagnosis of primary malignant pericardial mesothelioma was made following histopathological examination.

Copyright © 2011 Elsevier Inc. All rights reserved.

In plain English

This was a case report of one man diagnosed at autopsy with primary malignant mesothelioma of the pericardium, the sac around the heart. The 66-year-old was admitted with three weeks of shortness of breath and right shoulder pain, plus leg swelling. He was a nonsmoker with no apparent history of occupational or incidental asbestos exposure. An echocardiogram showed a large fluid collection around the heart. Doctors drained 1200 ml of fluid from the pericardium and one thousand milliliters from the left pleural space. He died the following day after unsuccessful resuscitation. At autopsy a malignant tumor encased the heart, thickening the pericardium to 12 mm (outer layer) and 10 mm (inner layer). The lining of the lungs was smooth. Microscopy showed a spindle cell tumor that stained positive for calretinin and thrombomodulin. The authors judged these findings consistent with primary spindle cell pericardial malignant mesothelioma that had spread to a 2 by 1 by 1 cm nodule in the right middle lobe of the lung. Statistics in the article's background and discussion come from earlier publications, not this case.

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 (single patient, diagnosed at autopsy), with a discussion of earlier published literature
• Who was studied: one 66-year-old man admitted with shortness of breath and right shoulder pain, transferred to the National Heart and Lung Institute, London, UK
• Exposure: no asbestos exposure identified; the patient was a nonsmoker with no apparent occupational or incidental asbestos exposure; no fiber type reported
• Main results:
  • Echocardiogram showed a large pericardial effusion; 1200 ml of straw-colored fluid was drained from the pericardium
  • One thousand milliliters of left pleural effusion was drained at the same time
  • The patient died the day after drainage despite resuscitation
  • At autopsy, a malignant tumor encased the heart on both visceral and parietal aspects
  • Parietal pericardium was 12 mm thick and visceral pericardium 10 mm thick
  • The pleura of the lungs was smooth
  • A 2×1×1 cm nodule was found in the right middle lobe of the lung beneath the pleura
  • The tumor was a spindle cell tumor that stained positive for calretinin and thrombomodulin; the lung nodule also stained positive for calretinin
• The authors' conclusion: The authors concluded the findings were consistent with a primary spindle cell pericardial malignant mesothelioma with metastasis in the right middle lobe of the lung

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, Pericardial Mesothelioma, Autopsy, Pericardial, Mesothelioma, Pleural Mesothelioma, Asbestos Exposure.

Related studies

• 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)
• Malignancies involving the pericardium — W.H. Warren (2000)
• Letter: Mesothelioma of the pericardium with cholesterol pericarditis — E. Argianas, K. Melissinos, et al. (1974)
• Malignant mesothelioma of the pericardium: case reports and immunohistochemical studies including Ki-67 expression — H. Hirano, T. Maeda, et al. (2002)

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