Primary malignant mesothelioma of the pericardium. Case report and literature review

Our plain-English summary of Primary malignant mesothelioma of the pericardium. Case report and literature review, by R. Thomason, W. Schlegel, M. Lucca, et al (Texas Heart Institute Journal, 1994).

The study

• Authors: R. Thomason, W. Schlegel, M. Lucca, S. Cummings, S. Lee
• Journal: Texas Heart Institute Journal
• Published: 1994;21(2):170-4
• Type of article: Case report, Review
• Cited by: 59 articles, as counted by NIH iCite
• Read it: PubMed · Free full text

Abstract

Pericardial mesothelioma is a highly lethal and fortunately rare cardiac neoplasm. We present the clinical and pathologic features of a primary sarcomatoid mesothelioma. To better understand the clinical, radiographic, and pathologic features of this entity, we reviewed 27 cases described in the English literature from 1972 through 1992, which, together with our case, provided a total of 28 cases. Findings of the review include a male-female ratio of 2:1, a wide age range (12 to 77 years; mean, 47 years), and documented asbestos exposure in 4 of 28 (14%) patients. Commonly used imaging studies do not appear to offer great sensitivity, for a mass was detected by echocardiography in only 2 of 16 (12%) patients and by computed tomography in 4 of 9 (44%). Pathologic findings revealed a diffuse growth pattern in most cases (18 of 25, or 72%), together with an equal distribution between the biphasic, epithelioid, and sarcomatoid variants. Effusion cytology revealed malignant cells in only 2 of 10 (20%) cases. With or without therapy, prognosis was uniformly poor, since 24 of 27 patients were dead of the disease at the time the reports were published.

In plain English

This article combined a case report with a review of published cases of primary malignant mesothelioma of the pericardium (the sac around the heart). The patient was a 36-year-old woman who arrived with signs of fluid compressing her heart. Her first fluid and tissue samples were negative for cancer. At a later operation a tumor was found encasing the heart. She died after a sudden cardiac arrest, and examination after death diagnosed sarcomatoid mesothelioma. No asbestos history is given for her. The authors reviewed 27 cases published in English from 1972 through 1992, giving 28 cases in all. Of these, 20 were male, and ages ranged from 12 to 77 years. Asbestos exposure was not mentioned in 16 cases. Where it was mentioned, 4 of 12 had exposure. A mass was seen by echocardiography in 2 of 16 and by computed tomography in 4 of 9. Fluid testing found malignant cells in 2 of 10. Of 27 patients, 24 were dead of the disease when reported. The authors called the disease highly lethal and stated that the role of asbestos as a cause is not certain.

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 one patient combined with a review of published case reports
• Who was studied: One 36-year-old woman seen at Wilford Hall Medical Center, Texas, in October 1992, plus 27 cases from the English-language literature published 1972 through 1992 (28 cases in total)
• Exposure: Asbestos exposure as recorded in the reviewed case reports. No fiber types are named, and no asbestos history is given for the authors' own patient. The authors state that asbestos's role as a cause of pericardial mesothelioma is not certain.
• Main results:
  • Case patient: a 36-year-old woman presented with signs of pericardial tamponade (fluid compressing the heart).
  • Case patient: her first pericardial fluid and tissue samples were negative for malignancy.
  • Case patient: she had a sudden, intractable cardiac arrest after sternotomy.
  • Case patient: pathology studies diagnosed primary pericardial sarcomatoid mesothelioma.
  • All 28 cases: male-female ratio of 2:1 (20 of 28 male); ages 12 to 77 years, mean 47 years
  • All 28 cases: asbestos exposure was not mentioned in 16 of 28 cases. Among the 12 where it was mentioned, 4 of 12 (33%) had exposure and 8 of 12 (67%) had no known exposure. The abstract expresses this as 4 of 28 (14%).
  • A pericardial mass was detected by echocardiography in 2 of 16 (12%) cases and by computed tomography in 4 of 9 (44%)
  • A diffuse growth pattern was found in 18 of 25 (72%) cases
  • Of 20 cases with tissue type reported: biphasic 7 of 20 (35%), epithelioid 7 of 20 (35%), sarcomatous 6 of 20 (30%)
  • Effusion cytology was malignant in 2 of 10 (20%) cases with results. The table lists 1 of 10 as inconclusive and 7 of 10 as benign.
  • 24 of 27 patients (89%) were dead of the disease when their reports were published
  • In the 20 fatal cases with a documented time course, patients lived an average of 3.5 months after presentation or start of therapy
  • In 1 of the 28 cases, a possible cure was achieved by surgical excision of a discrete tumor attached to the parietal pericardium
• The authors' conclusion: The authors concluded that pericardial mesothelioma is a highly lethal disease. They found common imaging lacks sensitivity, and chemotherapy and radiation appear of little benefit for non-resectable tumor.

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, Neoplasm, Sarcomatoid, Mesothelioma, Asbestos Exposure, Biphasic Mesothelioma.

Related studies

• Primary tumors and cysts of the heart and pericardium — H.A. McAllister (1979)
• Primary malignant mesothelioma of the pericardium — J. Patel, M.N. Sheppard (2011)
• Primary sarcomatoid malignant mesothelioma of the pericardium — T. Terada (2012)
• Primary pericardial mesothelioma: report of two cases and review of the literature — A.L. Sytman, R.N. MacAlpin (1971)
• Malignant mesothelioma arising after direct application of asbestos and fiber glass to the pericardium — A. Churg, M.L. Warnock, et al. (1978)
• Malignancies involving the pericardium — W.H. Warren (2000)

Browse return to medical research.