Primary pericardial tumors

Our plain-English summary of Primary pericardial tumors, by C.S. Restrepo, D. Vargas, D. Ocazionez, et al (Radiographics, 2013).

The study

• Authors: C.S. Restrepo, D. Vargas, D. Ocazionez, S. Martínez-Jiménez, S.L. Betancourt Cuellar, F.R. Gutierrez
• Journal: Radiographics
• Published: 2013;33(6):1613-30
• Type of article: Review
• Cited by: 115 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Primary pericardial tumors are rare and may be classified as benign or malignant. The most common benign lesions are pericardial cysts and lipomas. Mesothelioma is the most common primary malignant pericardial neoplasm. Other malignant tumors include a wide variety of sarcomas, lymphoma, and primitive neuroectodermal tumor. When present, signs and symptoms are generally nonspecific. Patients often present with dyspnea, chest pain, palpitations, fever, or weight loss. Although the imaging approach usually begins with plain radiography of the chest or transthoracic echocardiography, the value of these imaging modalities is limited. Cross-sectional imaging, on the other hand, plays a key role in the evaluation of these lesions. Computed tomography and magnetic resonance imaging allow further characterization and may, in some cases, provide diagnostic findings. Furthermore, the importance of cross-sectional imaging lies in assessing the exact location of the tumor in relation to neighboring structures. Both benign and malignant tumors may result in compression of vital mediastinal structures. Malignant lesions may also directly invade structures, such as the myocardium and great vessels, and result in metastatic disease. Imaging plays an important role in the detection, characterization, and staging of pericardial tumors; in their treatment planning; and in the posttreatment follow-up of affected patients. The prognosis of patients with benign tumors is good, even in the few cases in which surgical intervention is required. On the other hand, the length of survival for patients with malignant pericardial tumors is, in the majority of cases, dismal.

In plain English

This article was a review of tumors that start in the pericardium (the sac around the heart), focusing on how they look on CT, MR imaging and other scans. It did not study a group of patients. It drew on published literature and showed individual imaging cases. Citing earlier publications, the authors described primary pericardial tumors as rare. Pericardial cysts were the most common benign lesion, and mesothelioma was the most common primary malignancy, with a reported prevalence of 0.0022% in autopsy series. The authors noted that, unlike pleural mesothelioma, the association of pericardial mesothelioma with asbestos is still controversial. Citing other reports, they wrote that pericardial mesothelioma is more frequent in men, and that malignant cells are seen in fluid drawn from the pericardium in only 20% of cases. They also wrote that metastatic disease is found in about 50% of cases, and that survival ranges between 6 weeks and 15 months regardless of therapy. The authors concluded that CT and MR imaging are fundamental in evaluating these tumors.

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: Narrative review of primary pericardial tumors, written as an imaging education exhibit and illustrated with individual cases
• Who was studied: No study population. The article reviewed published literature and showed individual imaging cases, for example a 65-year-old woman with primary pericardial mesothelioma.
• Exposure: Exposure was not studied. Asbestos was mentioned only in noting, with a citation, that its association with pericardial mesothelioma is still controversial, in contrast to pleural mesothelioma.
• Main results:
  • Citing earlier work, the authors stated that primary malignant pericardial mesothelioma has a reported prevalence of 0.0022% in autopsy series and is the most common primary malignancy of the pericardium.
  • Citing earlier work, the authors stated that pericardial mesothelioma occurs more often in men than women, most often in the 5th through 7th decades of life.
  • Citing a published report, the authors stated that malignant cells are seen in pericardial fluid drawn by pericardiocentesis in only 20% of pericardial mesothelioma cases.
  • Citing a published report, the authors stated that metastatic disease is found in about 50% of pericardial mesothelioma cases, most often in local mediastinal lymph nodes and the lungs.
  • Citing a published report, the authors stated that survival with pericardial mesothelioma ranges from 6 weeks to 15 months, regardless of therapy.
  • On CT and MR images, the authors described pericardial mesothelioma as a heterogeneously enhancing mass involving both layers of the pericardium.
  • Based on figures from earlier studies, the authors estimated the prevalence of all primary pericardial tumors at about 0.001 to 0.007%.
• The authors' conclusion: The authors concluded that CT and MR imaging are fundamental in evaluating primary pericardial tumors, may sometimes fully characterize them, and that the radiologist can play a key role in these patients' care.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial, Mesothelioma, Neoplasm, Sarcoma, Dyspnea, Mediastinal Structures, Staging, Prognosis.

Related studies

• Primary sarcomatoid malignant pericardial mesothelioma — D. Jiang, M. Kong, et al. (2013)
• Surgical pathology of primary cardiac and pericardial tumors — C. Basso, M. Valente, et al. (1997)
• Primary pericardial mesothelioma: report of two cases and review of the literature — A.L. Sytman, R.N. MacAlpin (1971)
• Primary pericardial mesothelioma — N.T. Eren, A.R. Akar (2002)
• A case of primary pericardial mesothelioma detected by 18F-FDG PET/CT — F. Aga, Y. Yamamoto, et al. (2012)
• Primary pericardial mesothelioma in a 19-year-old presenting as pericarditis — M.O. Kayatta, S.P. Dineen, et al. (2013)

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