Sarcomatoid Type Primary Pericardial Mesothelioma with a Long-term Survival after the Onset of Cardiac Tamponade

Our plain-English summary of Sarcomatoid Type Primary Pericardial Mesothelioma with a Long-term Survival after the Onset of Cardiac Tamponade, by C. Saisho, H. Ishii, N. Edakuni, et al (Internal Medicine, 2016).

The study

• Authors: C. Saisho, H. Ishii, N. Edakuni, Y. Imamura, T. Tokito, T. Kinoshita, K. Azuma, K. Yamada, T. Hoshino
• Journal: Internal Medicine
• Published: 2016;55(21):3161-3164
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary pericardial malignant mesothelioma is a very rare clinical entity and its prognosis is very poor. We herein report a 67-year-old man who presented with pericardial mesothelioma that was diagnosed 21 months after the onset of cardiac tamponade as the initial manifestation. Despite undergoing pericardiocentesis and surgical pericardial fenestration at the onset of cardiac tamponade, we were unable to make a conclusive diagnosis of mesothelioma based on the cytological and histological findings. This unusual case had a relatively long progression-free period without treatment before the appearance of pleural tumors that showed the histological features of malignant sarcomatoid mesothelioma.

In plain English

This case report describes one 67-year-old Japanese man at Kurume University Hospital. In January 2010 he developed cardiac tamponade, meaning fluid around the heart was pressing on it. He had no history of asbestos exposure, and no asbestos bodies were found in his tissue samples. The fluid was drained but returned within a week. He then had surgery to create a window in the heart lining (pericardium) and take a biopsy. Atypical cells were seen, but a definite diagnosis of mesothelioma could not be made. After the surgery the fluid did not return, and he was closely followed without anticancer treatment. At 21 months, tumors appeared on the lining of the left chest cavity. A biopsy led to a final diagnosis of sarcomatoid type primary pericardial malignant mesothelioma. Cisplatin and pemetrexed produced a partial response, but the disease later progressed despite further treatment, and he died in November 2013. The authors called the case unusual for its long period without progression before treatment. They concluded that clinicians should consider this disease in patients with pericardial fluid of unknown cause.

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
• Who was studied: One 67-year-old Japanese man with a 50 pack-year smoking history. He was taken to a local hospital in January 2010 and transferred to Kurume University Hospital, Japan.
• Exposure: None identified. The patient had no history of asbestos exposure, and no asbestos bodies were found in tissue samples from the pericardium and the pleural nodule. The authors found no evidence of other risk factors and said the cause in this patient was unclear.
• Main results:
  • At the onset of cardiac tamponade, the drained pericardial fluid showed a tiny amount of atypical cells suggestive of malignancy. This was not enough for a definitive diagnosis.
  • One week after the fluid was drained (pericardiocentesis), the pericardial fluid had built up again.
  • The pericardial biopsy showed spindle-shaped atypical cells suggesting possible sarcomatoid mesothelioma. These could not be distinguished from reactive mesothelial cells.
  • After surgical pericardial fenestration, the pericardial fluid did not build up again, and the patient was closely followed up.
  • Pleural tumors appeared in the left thoracic cavity 21 months after the onset of cardiac tamponade.
  • A biopsy of the pleural tumor showed cells matching the earlier pericardial tissue. The final diagnosis was sarcomatoid type primary pericardial malignant mesothelioma.
  • The pleural tumors were considered likely to have resulted from spread of pericardial mesothelioma cells due to the pericardial fenestration into the left thoracic cavity.
  • First-line cisplatin and pemetrexed for four cycles resulted in a partial response. After 14 cycles of maintenance pemetrexed, a tumor appeared in the cardiac chamber.
  • Second-line carboplatin and gemcitabine was given for three cycles, but the disease progressed. The patient received palliative care and died in November 2013.
• The authors' conclusion: The authors concluded that the case was unusual because of the relatively long progression-free period without treatment. They stated that clinicians should include pericardial mesothelioma in the differential diagnosis of pericardial effusion of unknown cause.

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: Sarcomatoid, Pericardial Mesothelioma, Cardiac Tamponade, Pericardial, Malignant Mesothelioma, Prognosis, Pericardiocentesis, Mesothelioma.

Related studies

• Cardiac tamponade as the initial manifestation of primary pericardial mesothelioma — M. Stein, A. Neuman, et al. (1995)
• Successful palliation for an aged patient with primary pericardial mesothelioma — R. Isoda, H. Yamane, et al. (2015)
• An unusual case of cardiac tamponade following electrical cardioversion — G.A. Jessurun, H.J. Crijns, et al. (1996)
• Unexpected malignant pericardial mesothelioma presenting as pericardial constriction — M. Oc, B. Oc, et al. (2012)
• Surgical pathology of primary cardiac and pericardial tumors — C. Basso, M. Valente, et al. (1997)
• Three-year survival after surgery for primary malignant pericardial mesothelioma: report of a case — K. Fujita, M. Hata, et al. (2014)

Browse more research in Internal Medicine, or return to medical research.