Primary Malignant Pericardial Mesothelioma: A Clinical Case Series Illustrating the Necessity of a Multidisciplinary Approach

Our plain-English summary of Primary Malignant Pericardial Mesothelioma: A Clinical Case Series Illustrating the Necessity of a Multidisciplinary Approach, by A.N. Rosenbaum, M.C. Bois, X. Zhang, et al (JACC. Case Reports, 2019).

The study

• Authors: A.N. Rosenbaum, M.C. Bois, X. Zhang, W.L. Santivasi, W.K. Freeman
• Journal: JACC. Case Reports
• Published: 2019;1(2):202-207
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary malignant pericardial mesothelioma is a rare cardiac neoplasm. The authors evaluated risk factors, clinical presentation, and outcomes by reviewing all biopsy-confirmed cases at one institution. The use of multimodality imaging, detailed hemodynamic assessment for the presence of an effusive-constrictive profile, and cytology evaluation can support the diagnosis. (Level of Difficulty: Advanced.).

© 2019 The Authors.

In plain English

This was a retrospective review of all patients at Mayo Clinic with biopsy-confirmed primary malignant pericardial mesothelioma, a cancer of the sac around the heart. The authors identified 6 patients diagnosed between 2001 and 2015 and described their risk factors, heart findings, treatment and survival. Mean age at diagnosis was 50 years (range 23 to 71). Four patients had smoked, and 2 had received earlier radiation therapy to the chest. Asbestos exposure was clearly identified in only 1 patient, and the article does not name a fiber type. The authors wrote that, with only one exposed patient, their data do not give a definitive link between asbestos and this cancer, and that the link remains controversial. Four patients had effusive-constrictive pericarditis. Diagnosis came about 21 months after symptoms began. Median survival was 8.4 months after diagnosis (range 30 to 837 days). The authors concluded that combined imaging, measurement of pressures in the heart, and testing of fluid cells can give clues to the diagnosis, and that outcomes remain poor. They noted that the group was small and that information came only from medical records.

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: Retrospective single-institution case series (review of medical records)
• Who was studied: 6 patients with biopsy-confirmed primary malignant pericardial mesothelioma at Mayo Clinic, identified between 2001 and 2015 (4 women and 2 men, aged 23 to 71)
• Exposure: Putative risk factors reviewed from records: tobacco, prior radiation therapy, prior cancer, asbestos exposure (no fiber type or source given), family history. Asbestos exposure was identified in 1 of 6 patients.
• Main results:
  • Mean age at diagnosis was 50 years (range 23 to 71 years) in the 6 patients
  • 4 of 6 patients (67%) had used tobacco, averaging 48 pack-years
  • 2 of 6 patients had prior radiation therapy to the chest
  • Only 1 patient was asbestos-exposed. The authors stated their data give no definitive link between asbestos and pericardial mesothelioma, and that the link remains controversial.
  • Diagnosis was delayed by about 21 months from the onset of symptoms
  • 4 of 6 patients (67%) presented with effusive-constrictive pericarditis
  • 2 of 6 patients (33%) presented with cardiac tamponade requiring drainage of fluid (pericardiocentesis)
  • In the 2 patients whose pericardial fluid was analyzed, the results were indeterminate for malignancy
  • Diagnosis in all 6 patients was made by open surgical biopsy
  • Median survival after diagnosis was 8.4 months (257 days; range 30 to 837 days) for the 6 patients
  • In this cohort, chemotherapy did not seem to offer a survival advantage, and pericardiectomy was not associated with long-term benefit
• The authors' conclusion: The authors concluded that multimodality imaging, detailed hemodynamic assessment for an effusive-constrictive profile, and novel cytology evaluation can provide clues to the diagnosis, which calls for multidisciplinary collaboration, and that clinical outcome remains poor despite advances in chemotherapy.
• Limitations the authors state:
  • Small cohort size
  • Data were not collected prospectively, so risk-factor information was limited to what was in the medical record
  • Any true effect of therapy cannot be determined because of selection bias and the small number of patients

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Multidisciplinary Team, Neoplasm, Biopsy, Cytology.

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