Recurrence of Pericardial Mesothelioma Affecting the Myocardium After Pericardial Resection

Our plain-English summary of Recurrence of Pericardial Mesothelioma Affecting the Myocardium After Pericardial Resection, by M. Rodríguez, H.R. Mallidi, A. da Silva, et al (The Annals of Thoracic Surgery, 2018).

The study

• Authors: M. Rodríguez, H.R. Mallidi, A. da Silva, R. Bueno
• Journal: The Annals of Thoracic Surgery
• Published: 2018;106(5):e243-e245
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Primary pericardial mesothelioma represents less than 1% of all malignant mesotheliomas. These tumors are very rare, difficult to diagnose, and have a poor response to established treatments. Common clinical presentations include constrictive symptoms, cardiac tamponade, and cardiac failure. Surgical resection can be curative in early stages and for localized tumors, and pericardiectomy and chemotherapy are often used as palliative approaches. We present the case of a 54-year-old woman who has so far survived 4 years after a primary resection of a pericardial mesothelioma and was referred with myocardial and aortopulmonary window recurrences for further treatment.

Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This is a case report from Brigham and Women's Hospital in Boston about one 54-year-old woman with epithelioid malignant mesothelioma of the pericardium, the sac around the heart. Her symptoms began in 2013 with right shoulder pain and shortness of breath. A large fluid collection around the heart was drained, and a pericardial mass found six months later was diagnosed as epithelioid malignant mesothelioma. The mass was removed, and she then had 4 cycles of cisplatin and pemetrexed chemotherapy and radiation (45 Gy). Scans every 3 months showed no recurrence until April 2017. The disease then returned in the pericardium and in a lymph node between the aorta and pulmonary artery, and imaging showed invasion of the heart muscle at the tip of the left ventricle. After 3 cycles of carboplatin and pemetrexed, surgeons removed all the masses, including the whole pericardium and parts of both ventricles. A nerve was sacrificed, which paralyzed her left vocal cord. She showed no signs of recurrence 4 months after surgery. The article does not report whether she had been exposed to asbestos. The authors concluded that surgical resection provides the best long-term survival option.

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 a single patient
• Who was studied: One 54-year-old woman with recurrent pericardial mesothelioma, seen at Brigham and Women's Hospital, Boston. She had a history of bilateral breast cancer in 2005 treated with mastectomies without radiotherapy. Her symptoms began in 2013.
• Exposure: The article does not report any asbestos exposure, occupation or fiber type for this patient. Asbestos is mentioned only as background from other literature.
• Main results:
  • The patient's first diagnosis was epithelioid malignant mesothelioma, made by fine needle aspiration of a pericardial mass found six months after a pericardial window. The earlier pericardial fluid had shown no malignant cells.
  • Initial treatment was resection of the pericardial mass, then 4 cycles of cisplatin and pemetrexed and external beam radiation (45 Gy). CT scans every 3 months showed no recurrence until April 2017.
  • At recurrence, after 3 cycles of carboplatin and pemetrexed, lesions in the aorto-pulmonary window, along the left ventricle and at the cardiac apex were unchanged in size and measured between 2 and 2.5 cm. MRI showed invasion of the left ventricle at the apex.
  • The patient had a repeat sternotomy with complete resection of all masses. This included total pericardiectomy and partial left and right ventricle resection on cardiopulmonary bypass.
  • The only postoperative complication reported was left recurrent nerve paralysis, because the nerve was sacrificed to remove the aorto-pulmonary window node. She was discharged on postoperative day 5.
  • Final pathology of all masses was epithelioid malignant mesothelioma. Four months after surgery the patient showed no signs of recurrence.
• The authors' conclusion: The authors concluded that pericardial mesotheliomas respond poorly to radiation and chemotherapy, and that surgical resection, as in this case, provides the best long-term survival option. They also wrote that total macroscopic resection is mandatory to try to prevent local recurrence.

Topics

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

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

Related studies

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• Recurrent pericardial effusion with pericardial amyloid deposition: a case report and literature review — H. Itagaki, T. Yamamoto, et al. (2020)
• Primary sarcomatoid malignant pericardial mesothelioma — D. Jiang, M. Kong, et al. (2013)
• Chest wall resection for mesothelioma recurrence after surgery — P. Bertoglio, O. Fanucchi, et al. (2016)
• Pericardial mesothelioma masquerading as a benign pericardial effusion — N.L. Coplan, A.J. Kennish, et al. (1984)
• 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)

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