Primary malignant pericardial mesothelioma presenting with cardiac tamponade

Our plain-English summary of Primary malignant pericardial mesothelioma presenting with cardiac tamponade, by S. Matsuyama, T. Imazuru, M. Uchiyama, et al (International Journal of Surgery Case Reports, 2020).

The study

• Authors: S. Matsuyama, T. Imazuru, M. Uchiyama, H. Ota, M. Iida, T. Shimokawa
• Journal: International Journal of Surgery Case Reports
• Published: 2020;73:253-256
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Primary malignant pericardial mesothelioma is a rare tumor that is very difficult to diagnose. Furthermore, it is a lethal disease, because patients usually have progressed at the time of referral.

Presentation Of The Case: We report a 44-year-old man with primary malignant pericardial mesothelioma. He was referred to our hospital for the diagnosis and treatment of a massive pericardial effusion and huge tumor. Pericardiocentesis was performed, but we could not obtain definitive diagnosis, and the cardiac tamponade continued along with the signs/symptoms. He required surgical intervention for the diagnosis and treatment. After surgery, his signs/symptoms improved. He received adjuvant therapy, although he died 7 months after surgery.

Discussion: Primary malignant pericardial mesothelioma is a rare tumor. The most common signs and symptoms are related to constriction of the heart by the tumor and/or effusion. Even if the pericardial fluid specimen obtained by pericardiocentesis is negative for malignant cells, primary malignant pericardial mesothelioma should be included in the differential diagnosis. Because the malignancy is usually advanced at the time of diagnosis, it has been difficult to cure. Radiation and chemotherapy have been used in addition to surgery, but have been minimally effective.

Conclusion: The outcome of our patient with pericardial malignant mesothelioma was dismal. The indications for surgical intervention should be carefully considered except for critical cases requiring alleviation of immediate life-threating conditions.

Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

In plain English

This case report described one 44-year-old man in Japan with primary malignant pericardial mesothelioma, a cancer of the sac around the heart. About 2 months before admission, he had gone to a regional hospital with worsening breathlessness on exertion and leg swelling. The authors reported he had no obvious history of occupational or incidental asbestos exposure. Scans showed a large fluid collection around the heart and a tumor measuring 95 by 99 mm. Fluid drawn off with a needle did not show cancer cells, and the pressure on his heart (cardiac tamponade) continued. Surgeons opened the chest and removed as much tumor as possible. It weighed 480 g and was diagnosed as malignant mesothelioma, sarcomatoid type, and fluid taken at surgery did show malignant cells. His symptoms improved, but the tumor grew despite carboplatin and pemetrexed chemotherapy and radiation, and he died 7 months after surgery. The authors concluded that, because the outlook is very poor, surgery should be carefully considered, except in critical cases where the tumor constricts the heart or suppresses its function.

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)
• Who was studied: One 44-year-old man who had gone to a regional hospital with worsening breathlessness on exertion and leg swelling about 2 months before admission, and was then referred to the authors' hospital in Tokyo, Japan. The article does not give the year of treatment.
• Exposure: No obvious history of occupational or incidental asbestos exposure was reported for the patient. No fiber type is mentioned.
• Main results:
  • Imaging showed massive pericardial effusion (maximum 53 mm) and a large tumor measuring 95 by 99 mm in the lateral to posterior pericardial space.
  • Fluid obtained by pericardiocentesis before surgery was grade II on cytology and negative for malignant cells.
  • The resected tumor weighed 480 g.
  • The tumor was diagnosed on histopathology as malignant mesothelioma, sarcomatoid type.
  • Pericardial fluid obtained at surgery showed grade V cytology (malignant cells).
  • PET-CT showed increased uptake in the mediastinal and subcarinal lymph nodes.
  • The patient's symptoms improved after surgery, and his early postoperative course was uneventful.
  • Carboplatin and pemetrexed were started 3 weeks after surgery, but the tumor progressed.
  • Radiation gave a temporary reduction in tumor size.
  • Chemotherapy was stopped because of blood toxicity.
  • The patient died 7 months after surgery, which was 9 months after his first symptoms.
• The authors' conclusion: The authors concluded that, because the prognosis of primary malignant pericardial mesothelioma is very poor, the indications for surgery should be carefully considered, except for critical cases with pericardial constriction or suppression of cardiac function by the tumor.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Cardiac Tamponade, Pericardial Effusion, Pericardiocentesis, Adjuvant Therapy, Pericardial, Differential Diagnosis, Chemotherapy.

Related studies

• Primary Malignant Pericardial Epithelioid Mesothelioma Presenting as Cardiac Tamponade: A Case Report With Multimodality Imaging and Radiologic-Pathologic Correlation — S. Dhakal, P. Savoia, et al. (2026)
• Cardiac tamponade as the initial manifestation of primary pericardial mesothelioma — M. Stein, A. Neuman, et al. (1995)
• Sarcomatoid Type Primary Pericardial Mesothelioma with a Long-term Survival after the Onset of Cardiac Tamponade — C. Saisho, H. Ishii, et al. (2016)
• Cardiac tamponade in a cat with pericardial mesothelioma — F. Spina, M. Orlandi, et al. (2026)
• Fatal hemopericardial tamponade due to primary pericardial mesothelioma: a case report — D.C. Lingamfelter, D. Cavuoti, et al. (2009)
• Primary cardiac mesothelioma presenting with fulminant recurrent pericarditis: a case report — S. Schwartzenberg, Y. Shapira, et al. (2023)

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