Primary malignant pericardial mesothelioma with increased serum mesothelin diagnosed by surgical pericardial resection: A case report

Our plain-English summary of Primary malignant pericardial mesothelioma with increased serum mesothelin diagnosed by surgical pericardial resection: A case report, by T. Kurosawa, K. Sugino, K. Isobe, et al (Molecular and Clinical Oncology, 2016).

The study

• Authors: T. Kurosawa, K. Sugino, K. Isobe, Y. Hata, Y. Fukasawa, S. Homma
• Journal: Molecular and Clinical Oncology
• Published: 2016;5(5):553-556
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 37-year-old female smoker without a history of exposure to asbestos was referred to our hospital with persistent pericardial effusion. Chest computed tomography imaging examination revealed an irregular thickened pericardium with large amounts of pericardial effusion and a small pleural effusion. Fluorodeoxyglucose (FDG) positron emission tomography imaging demonstrated intrapericardial FDG accumulation. Blood tests revealed an increase in serum mesothelin levels. Examination of a surgically resected specimen revealed a grayish-white thickening of the pericardium, with a straw-colored mucinous pericardial effusion. Histopathological examination confirmed the diagnosis of epithelioid malignant mesothelioma. Although the patient's condition temporarily improved, with decreased levels of serum mesothelin during chemotherapy with carboplatin and pemetrexed, she succumbed to cardiac tamponade 18 months after the initial onset of the symptoms. Primary malignant pericardial mesothelioma (PMPM) is an extremely rare and refractory disorder. Thus, an early definitive diagnosis and timely treatment are crucial for the management of PMPM.

In plain English

This case report describes one patient treated at Toho University Omori Medical Center in Tokyo, Japan. A 37-year-old woman with worsening breathlessness and chest pain was referred because of persistent fluid around the heart (pericardial effusion). The authors reported that she had no past history of asbestos exposure, and that no asbestos bodies were found on tissue examination at autopsy. Her blood level of mesothelin, a protein studied as a marker of mesothelioma, was 18.5 nmol/l, against a normal range of below 1.5 nmol/l. Scans showed a thickened pericardium. Fluid testing first suggested adenocarcinoma. A surgical biopsy and special tissue stains then led to a diagnosis of primary malignant pericardial mesothelioma of epithelioid type. During chemotherapy with carboplatin and pemetrexed, her condition temporarily improved and her mesothelin level fell. Afterwards she worsened, her mesothelin rose, and she died of cardiac tamponade 18 months after her symptoms began. The authors said this survival was longer than in previously reported cases. They hypothesized that changes in mesothelin may track the disease, and concluded that timely diagnosis and early treatment are crucial.

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 37-year-old woman referred to Toho University Omori Medical Center, Tokyo, Japan, for persistent pericardial effusion
• Exposure: The patient had no reported history of asbestos exposure, and no asbestos bodies were found on histological examination at autopsy
• Main results:
  • The patient's serum mesothelin at presentation was 18.5 nmol/l (normal range below 1.5 nmol/l)
  • Pericardial fluid cytology suggested adenocarcinoma, but surgical biopsy with immunohistochemistry (positive for calretinin, D2-40 and HBME-1; negative for CEA and TTF-1) led to a diagnosis of epithelioid-type primary malignant pericardial mesothelioma
  • During chemotherapy with carboplatin and pemetrexed, the patient's condition temporarily improved and serum mesothelin fell
  • After chemotherapy the patient's condition worsened and mesothelin rose. She had pleurodesis but no further chemotherapy, and died of cardiac tamponade 18 months after symptom onset
  • The authors stated that the patient's 18-month survival was longer than in cases reported in previous studies
• The authors' conclusion: The authors hypothesized that serial changes in serum mesothelin may correlate with PMPM and its status. They concluded that timely definitive diagnosis and treatment in the early stages of PMPM are crucial.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Mesothelin, Pericardial, Pericardial Effusion, Pericardium, Pleural Effusion, Epithelioid, Malignant Mesothelioma.

Related studies

• Individual predictors of increased serum mesothelin in asbestos-exposed workers — R. Filiberti, P. Marroni, et al. (2013)
• Surgical pathology of primary cardiac and pericardial tumors — C. Basso, M. Valente, et al. (1997)
• Surgical treatment of a primary malignant pericardial mesothelioma: case report — G. Apicella, A. Boulemden, et al. (2022)
• Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low-risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection — D.J. Sugarbaker, R.R. Gill, et al. (2013)
• Improving surgical resection rate in lung cancer — C. Laroche, F. Wells, et al. (1998)
• Survival by Histologic Subtype of Malignant Pleural Mesothelioma and the Impact of Surgical Resection on Overall Survival — V. Verma, C.A. Ahern, et al. (2018)

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