Primary malignant sarcomatoid mesothelioma in the pericardium

Our plain-English summary of Primary malignant sarcomatoid mesothelioma in the pericardium, by K. Tateishi, M. Ikeda, T. Yokoyama, et al (Internal Medicine, 2013).

The study

• Authors: K. Tateishi, M. Ikeda, T. Yokoyama, K. Urushihata, H. Yamamoto, M. Hanaoka, K. Kubo, Y. Sakai, J. Nakayama, T. Koizumi
• Journal: Internal Medicine
• Published: 2013;52(2):249-53
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Primary malignant pericardial mesothelioma is an exceptionally rare tumor, and making an antemortem diagnosis of this disease is notoriously difficult. We herein report the case of a 61-year-old woman with pericardial mesothelioma who presented with shortness of breath and peripheral edema of the lower limbs. Chest computed tomography (CT) showed an anterior mass and thickened pericardium with multiple pericardial nodules. A biopsy of the mediastinal mass was performed using right thoracotomy, and the histological findings indicated a sarcomatoid tumor. The patient was treated with chemotherapy; however, she but died three months after diagnosis. An autopsy confirmed a final diagnosis of sarcomatoid type primary malignant pericardial mesothelioma following extensive immunohistopathological examinations.

In plain English

This article is a case report about one 61-year-old woman in Japan with primary malignant mesothelioma of the pericardium (the sac around the heart), of the sarcomatoid type. She had six months of shortness of breath on exertion and swelling of the lower legs. The article states she had no history of occupational or incidental exposure to asbestos. Chest CT showed an anterior mass and a thickened pericardium, and PET scanning showed abnormal uptake in the anterior mediastinum and multiple pericardial lesions. A biopsy pointed to sarcomatoid carcinoma, and the doctors first diagnosed sarcomatoid carcinoma of the thymus. Platinum-based chemotherapy brought no clinical improvement, and she died three months after diagnosis. At autopsy the tumor had infiltrated and grown in the pericardium and heart muscle and had invaded the pericardial cavity. Based on the autopsy and staining tests, the authors diagnosed sarcomatoid-type primary malignant pericardial mesothelioma. No pleural or pericardial plaques or asbestos bodies were found. The authors concluded that pericardial tumors should be considered in patients with signs of right heart dysfunction, and that staining tests help reach a final diagnosis.

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 (one patient, with autopsy)
• Who was studied: One 61-year-old woman admitted to the authors' hospital (Shinshu University School of Medicine, Japan) with a six-month history of shortness of breath on exertion and lower leg swelling; she had diabetes and dyslipidemia. Dates of care are not given.
• Exposure: No asbestos exposure reported. The article states the patient had no history of occupational or incidental asbestos exposure, and no pleural or pericardial plaques or asbestos bodies were observed.
• Main results:
  • Chest CT showed an anterior mass and a thickened pericardium with multiple pericardial nodules.
  • FDG-PET showed abnormal uptake in the anterior mediastinum (SUVmax 19.5) and multiple pericardial lesions.
  • Cardiac catheterization showed a dip and plateau pattern of pressures in both ventricles.
  • A biopsy of the mediastinal mass, taken by video-assisted thoracoscopic surgery, was consistent with sarcomatoid carcinoma, and a diagnosis of sarcomatoid carcinoma of the thymus was made.
  • Several platinum-based combination chemotherapies gave no clinical improvement. The patient died three months after diagnosis and nine months after symptoms began.
  • At autopsy the tumor had infiltrated and grown in the pericardium and myocardium (heart muscle) and invaded the pericardial cavity.
  • On staining tests, tumor cells were positive for cytokeratin AE1/AE3 and vimentin and showed focal positivity for D2-40. Calretinin and cytokeratin 5/6 were negative.
  • The authors diagnosed sarcomatoid-type primary malignant pericardial mesothelioma and believed death was due to cardiac compression by the tumor.
  • No pleural or pericardial plaques or asbestos bodies were observed.
• The authors' conclusion: The authors concluded that pericardial tumors should be considered in patients with clinical signs of right heart dysfunction, even with atypical imaging, and that immunohistological analyses are useful for making a final diagnosis, even in unusual sites.
• Limitations the authors state:
  • The authors note that calretinin was negative in this case, unlike other reported sarcomatoid mesotheliomas, and that the significance of this finding remains unclear.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Sarcomatoid, Mesothelioma, Pericardium, Pericardial Mesothelioma, Pericardial, Biopsy, Thoracotomy, Chemotherapy.

Related studies

• Primary sarcomatoid malignant mesothelioma of the pericardium — T. Terada (2012)
• Primary sarcomatoid malignant pericardial mesothelioma — D. Jiang, M. Kong, et al. (2013)
• Primary malignant mesothelioma of the pericardium — J. Patel, M.N. Sheppard (2011)
• 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)
• Multicystic mesothelioma of the pericardium — S. Morita, A. Goto, et al. (2011)

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