Primary pericardial mesothelioma in a 19-year-old presenting as pericarditis

Our plain-English summary of Primary pericardial mesothelioma in a 19-year-old presenting as pericarditis, by M.O. Kayatta, S.P. Dineen, G. Sica, et al (The Annals of Thoracic Surgery, 2013).

The study

• Authors: M.O. Kayatta, S.P. Dineen, G. Sica, J.D. Puskas, A. Pickens
• Journal: The Annals of Thoracic Surgery
• Published: 2013;96(2):680-1
• Type of article: Case report
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Primary pericardial mesothelioma is a rare clinical entity. The association between asbestos and pericardial mesothelioma has not been well established, partly due to the small number of reported patients. Treatment options are limited for this very aggressive cancer. Surgical resection in the form of pericardiectomy can be curative, but owing to the frequently late presentation, surgical intervention is usually palliative. Chemotherapy and radiotherapy have overall poor results. We present the case of a 19-year-old man who initially had symptoms of pericarditis. He died 1 year after initial presentation.

Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This case report described a 19-year-old man diagnosed with primary pericardial mesothelioma, a cancer of the lining around the heart. He was a nonsmoker with a history of childhood asthma, and the authors reported that he had no occupational exposure to asbestos. He first went to the emergency department with chest and abdominal pain and was diagnosed with pericarditis. An echocardiogram showed a large fluid collection around the heart with signs of tamponade (compression of the heart). The fluid was drained, and it showed reactive mesothelial cells. His symptoms returned over the following weeks, and tests were consistent with constrictive pericarditis. During surgery to remove the pericardium, it was markedly thickened, in some areas nearly 2 cm thick. Pathology showed malignant mesothelioma, and a later review of the original fluid found malignant mesothelial cells. Despite aggressive therapy, he died 1 year after first presenting. The authors noted that cytology of pericardial fluid is often negative, as it first was in this patient. They also noted that removing the pericardium partially relieved the constriction of his heart.

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 19-year-old man, a nonsmoker with a history of childhood asthma, who presented with chest and abdominal pain; no location of treatment or dates given beyond the authors' affiliation (Emory University, Atlanta, Georgia)
• Exposure: The authors reported no occupational exposure to asbestos; no other asbestos exposure information was given
• Main results:
  • The first echocardiogram showed a large pericardial effusion with evidence of tamponade
  • The pericardial fluid from the first drainage showed reactive mesothelial cells
  • Later imaging and cardiac catheterization findings were consistent with constrictive pericarditis, and he was referred for pericardiectomy
  • At surgery the pericardium was markedly thickened and adherent to the heart, nearly 2 cm thick in some areas
  • Central venous pressure fell from 30 to 15 mm Hg during the operation
  • Pathology of the removed pericardium showed malignant mesothelioma, of the epithelioid type
  • A retrospective review of the original pericardiocentesis fluid did show malignant mesothelial cells
  • The patient died 1 year after his initial presentation despite aggressive therapy
  • The authors stated that pericardiectomy partially relieved the functional constriction in this patient
• The authors' conclusion: The authors presented the case as showing how difficult pericardial mesothelioma is to diagnose, noting that cytology of pericardial fluid is often negative, as it originally was in this patient

Topics

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

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Surgical Resection, Pericardiectomy, Palliative Care, Chemotherapy.

Related studies

• Letter: Mesothelioma of the pericardium with cholesterol pericarditis — E. Argianas, K. Melissinos, et al. (1974)
• Pericardial mesothelioma presenting as a suspected ST-elevation myocardial infarction — A.S. Barroso, S. Leite, et al. (2017)
• Pericardial mesothelioma presenting as left atrial thrombus in a patient with mitral stenosis — Y. Miyamoto, S. Nakano, et al. (1996)
• Unexpected malignant pericardial mesothelioma presenting as pericardial constriction — M. Oc, B. Oc, et al. (2012)
• A second case of pericardial mesothelioma mimicking systemic lupus erythematosus in the literature in over 30 years: a case report — C. Mensi, A. Romano, et al. (2017)
• Pericardial Mesothelioma in a 35-Year-Old Male With Ulcerative Colitis — J. Iliff, N.K. Bart, et al. (2019)

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