Primary Pericardial Mesothelioma: Report of a Patient and Literature Review

Our plain-English summary of Primary Pericardial Mesothelioma: Report of a Patient and Literature Review, by A. Nilsson, T. Rasmuson (Case Reports in Oncology, 2009).

The study

• Authors: A. Nilsson, T. Rasmuson
• Journal: Case Reports in Oncology
• Published: 2009;2(2):125-132
• Type of article: Case report
• Cited by: 49 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary mesothelioma of the pericardium is a rare tumor and carries a dismal prognosis. This case report presents a 38-year-old man who suffered from recurrent pericardial fluid. Initial symptoms were unspecific, with dry cough and progressing fatigue. Pericardiocentesis was performed, but analyses for malignant cells and tuberculosis were negative. After recurrence a pericardiectomy was planned. At operation, partial resection of tumor tissue surrounding the heart was performed. Histopathologic examination including immunohistochemical staining for calretinin showed a biphasic mesothelioma. During the postoperative period the patient's condition ameliorated, but symptoms recurred and the patient died 3 months after diagnosis and 15 months after the first symptoms. At autopsy, the pericardium was transformed by the tumor that also expanded into the mediastinum and had set metastases to the liver. A review of 29 cases presented in the recent literature indicates a higher incidence of malignant pericardial mesothelioma among men than women. Median age was 46 (range, 19-76) years. In pleural mesotheliomas, exposure to asbestos is a known risk factor. However, in primary pericardial mesotheliomas the evidence for asbestos as an etiologic factor seems to be less convincing (3 exposed among 14 cases). Symptoms are often unspecific and cytologic examination of pericardial fluid is seldom conclusive (malignant cells demonstrated in 4/17 cases). Partial resection of the tumor can give a period of symptom reduction. Only a few patients have been treated with chemotherapy. Median survival of patients with pericardial mesotheliomas is approximately 6 months.

In plain English

This article described one patient with primary pericardial mesothelioma, a cancer of the lining around the heart, and reviewed 29 English-language cases published from 1993 through 2008. The patient, a 38-year-old metal worker originally from Cyprus, was treated in Umeå, Sweden. In November 2001 he was admitted with fluid compressing the heart, after several weeks of dry cough and fatigue. Tests of that fluid found no cancer cells. After repeated relapses, surgery in September 2002 found a biphasic mesothelioma. He died 3 months after diagnosis and 15 months after first symptoms. At autopsy the tumor surrounded the heart and had spread into the central chest and liver. The article does not say whether he was exposed to asbestos. Of 30 cases including his, 22 were men and 8 women, and the median age was 46. Of 14 cases with exposure information, 3 had known asbestos exposure. Cancer cells were found in pericardial fluid in 4 of 17 cases. Median survival from first symptoms was 6 months. The authors concluded that whether asbestos is related to this disease is uncertain.

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 of one patient combined with a review of published case reports
• Who was studied: One 38-year-old male metal worker originally from Cyprus, admitted to the authors' clinic in Umeå, Sweden, in October 2002. The review covered 29 published cases of primary pericardial mesothelioma from the English literature, 1993 through 2008, for 30 cases including the authors' patient.
• Exposure: Asbestos exposure as recorded in the reviewed case reports. No fiber types or doses are given. The article does not state whether the authors' own patient was exposed to asbestos.
• Main results:
  • In November 2001 the authors' patient was admitted to a local hospital with cardiac tamponade. By then he had had several weeks of dry cough and progressing fatigue.
  • In the authors' patient, the first analysis of pericardial fluid found no malignant cells.
  • The authors' patient had 3 relapses over the next 6 months and was referred for pericardiectomy in September 2002.
  • Tissue removed at surgery from the authors' patient showed biphasic mesothelioma of the pericardium, positive on staining for calretinin.
  • The authors' patient died 3 months after diagnosis and 15 months after first symptoms.
  • At autopsy, the tumor in the authors' patient had spread from the pericardium into the central mediastinum, and there was tumor spread to the liver.
  • Among the 30 cases (29 reviewed plus the authors' patient), the male-female ratio was 3:1 (22 men, 8 women in Table 1).
  • Among the 30 cases, the median age was 46 years (range 19 to 76).
  • Among the reviewed cases, 3 had known asbestos exposure and 11 had no known exposure (3 of 14 exposed). Most reviewed articles gave no exposure information, and Table 1 lists 16 of 30 cases where exposure was not mentioned.
  • Of 24 cases with a reported tissue pattern, 13 were epithelial, 7 biphasic and 4 fibrous or sarcomatoid.
  • Of 17 cases reporting pericardial fluid cytology, malignant cells were found in 4 (4 of 17 in Table 2; given as 24% in the text and 23% in the table).
  • Of 16 case reports with information on spread, 6 had no metastatic spread, 8 had regional lymph node involvement, 2 had liver metastases and 1 had lung metastases.
  • In the reviewed cases, median survival from first symptoms was 6 months.
• The authors' conclusion: The authors concluded that initial symptoms are unspecific, that whether asbestos exposure is related to primary pericardial mesothelioma is uncertain, that treatment options are limited, and that the prognosis is dismal.
• Limitations the authors state:
  • Most of the reviewed case reports gave no information about asbestos exposure.
  • Survival information was incomplete: 3 patients were alive when their reports were published, and 2 had no survival information.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Mesothelioma, Pericardium, Prognosis, Pericardial, Pericardiocentesis, Pericardiectomy, Immunohistochemistry.

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