Successful palliation for an aged patient with primary pericardial mesothelioma

Our plain-English summary of Successful palliation for an aged patient with primary pericardial mesothelioma, by R. Isoda, H. Yamane, S. Nezuo, et al (World Journal of Surgical Oncology, 2015).

The study

• Authors: R. Isoda, H. Yamane, S. Nezuo, Y. Monobe, N. Ochi, Y. Honda, S. Nishimura, M. Akiyama, T. Horio, N. Takigawa
• Journal: World Journal of Surgical Oncology
• Published: 2015;13:273
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

An 85-year-old Japanese man with a complaint of exertional dyspnea was admitted to our hospital. Sixty-three years prior to admission at our hospital, he handled asbestos for 2 years in a factory. His chest computed tomography showed a massive pericardial effusion leading to cardiac tamponade and right pleural plaque. After a pericardiocentesis was performed, he recovered from cardiac failure caused by the cardiac tamponade. Pathological examination of the pericardial effusion revealed malignant mesothelial cells. Therefore, he was diagnosed with primary pericardial mesothelioma (PPM) related to asbestos exposure. Although his disease slowly progressed over 18 months, he remained active without any adjuvant treatments such as chemotherapy. Long-term palliation in an aged patient with PPM is rarely obtained using supportive care alone because the prognosis of PPM has been consistently reported to be very poor and almost fatal within a year. Clinical oncologists and thoracic surgeons should be aware of this disease because the accumulation of knowledge on PPM may lead to successful treatment even in aged patients.

In plain English

This case report describes one 85-year-old Japanese man diagnosed with primary pericardial mesothelioma, a cancer of the lining around the heart. Sixty-three years before admission, he had handled asbestos for 2 years in a factory. The article does not name the type of asbestos. He came to hospital with chest discomfort and shortness of breath on exertion. Scans showed a large build-up of fluid around the heart that was compressing it (cardiac tamponade), and a scan 8 months later clearly showed pleural plaques. Doctors drained 2300 mL of bloody fluid with a needle, and his symptoms markedly improved. Malignant mesothelial cells were found in the fluid. Because of his age he received no chemotherapy, only a diuretic drug and supportive care. Scans at 8 and 16 months showed the fluid was well controlled. His fatigue and trunk pain slowly worsened, but he remained fully active 18 months after first presenting. The authors concluded that he had a slow-moving course with long-term relief of symptoms. They wrote that his disease was related to asbestos exposure, and that the reasons for his long survival were not clear.

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 (one patient)
• Who was studied: One 85-year-old Japanese man admitted to the authors' hospital in Japan (Kawasaki Medical School, Okayama). He had a 30 pack-year smoking history and a myocardial infarction 9 years earlier, and had worked as a gardener for about 40 years.
• Exposure: Handled asbestos for 2 years in a factory, 63 years before admission and before becoming a gardener. The fiber type is not stated.
• Main results:
  • Needle pericardiocentesis removed 2300 mL of bloody exudate from around the heart, and his chest discomfort and shortness of breath markedly improved.
  • Cells from the pericardial fluid were malignant mesothelial cells that stained positive for calretinin, D2-40 and WT1, and he was diagnosed with primary pericardial mesothelioma.
  • Pleural plaques were clearly shown on a chest CT 8 months after admission.
  • He received no chemotherapy, only best supportive care with a loop diuretic, and was discharged on the 20th day of hospitalization.
  • The maximum thickness of the fluid-filled space around the heart was 34.8 mm on admission, 3.3 mm at 8 months and 12.6 mm at 16 months.
  • General fatigue and trunk pain slowly progressed, but he remained fully active 18 months after his initial presentation.
• The authors' conclusion: The authors concluded that this aged patient had a slow-moving (indolent) clinical course with long-term palliation after pericardiocentesis and loop diuretics. They wrote that his pleural plaques suggested his disease was related to asbestos exposure, and that his tumor cells resembled epithelial mesothelioma.
• Limitations the authors state:
  • The authors state that the definite reasons for the long survival were not clear. They speculated that it was due to the properties of the tumor.

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, Dyspnea, Pericardial Effusion, Cardiac Tamponade, Pleural Plaques, Pericardiocentesis, Mesothelial Cells, Asbestos Exposure.

Related studies

• Sarcomatoid Type Primary Pericardial Mesothelioma with a Long-term Survival after the Onset of Cardiac Tamponade — C. Saisho, H. Ishii, et al. (2016)
• Cardiac tamponade as the initial manifestation of primary pericardial mesothelioma — M. Stein, A. Neuman, et al. (1995)
• Unexpected malignant pericardial mesothelioma presenting as pericardial constriction — M. Oc, B. Oc, et al. (2012)
• Pericardial mesothelioma masquerading as a benign pericardial effusion — N.L. Coplan, A.J. Kennish, et al. (1984)
• Pericardial Mesothelioma in a 35-Year-Old Male With Ulcerative Colitis — J. Iliff, N.K. Bart, et al. (2019)
• Recurrence of Pericardial Mesothelioma Affecting the Myocardium After Pericardial Resection — M. Rodríguez, H.R. Mallidi, et al. (2018)

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