Surgical treatment of a primary malignant pericardial mesothelioma: case report

Our plain-English summary of Surgical treatment of a primary malignant pericardial mesothelioma: case report, by G. Apicella, A. Boulemden, A. Citarella, et al (Acta Chirurgica Belgica, 2022).

The study

• Authors: G. Apicella, A. Boulemden, A. Citarella, R. Sushma, A. Szafranek
• Journal: Acta Chirurgica Belgica
• Published: 2022;122(1):48-50
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pericardial malignant mesothelioma (MM) is a rare tumour which accounts for about 1% of all mesotheliomas, 4% of the primary heart and pericardial tumours. It carries an extremely poor prognosis, with a reported overall survival of less than 6 months. Clinical symptoms and signs are frequently nonspecific, and the diagnosis is usually made after surgery or at autopsy. We report a case of a 72 years old woman with primary pericardial malignant mesothelioma involving the right atrium. Nine months following surgery, the patient is alive with good performance status.

In plain English

This is a case report from Nottingham University Hospitals, UK. It describes a 72-year-old woman with primary malignant pericardial mesothelioma involving the right atrium. She had six weeks of breathlessness, facial swelling, distended neck veins and headache. A CT scan showed an 87 x 76 mm right atrial mass compressing the superior vena cava, with no evidence of metastases. Biopsy was judged to risk significant bleeding; given the compression and no evidence of distant metastases, the team chose surgical removal. The tumour was deeply rooted in the atrial wall; complete removal was hardly achieved. Tissue was first diagnosed as metastatic squamous cell carcinoma, finally as epithelioid mesothelioma after further testing and expert review. Chemotherapy and radiotherapy were judged not beneficial while she remained well. A scan at five months suggested residual or recurrent disease. At seven months, a CT scan showed pericardial recurrence and pleural-based nodules suspicious for spread. The authors reported her alive with good performance status nine months after surgery. The article does not mention asbestos or other exposure. The authors concluded that surgery gave symptom relief here but remains palliative.

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 72-year-old woman treated at the Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK; dates of treatment not given
• Main results:
  • CT showed a mass of 87 x 76 mm in the right atrium, compressing the right atrium and distal superior vena cava; the CT showed no evidence of metastases
  • Biopsy was considered to carry a significant bleeding risk; resection was chosen in view of the local compressive effects and no evidence of distant metastases
  • At surgery the tumour was embedded in the epicardium and lateral atrial wall; complete macroscopic excision was hardly achieved
  • The initial diagnosis was metastatic squamous cell carcinoma; further immunohistochemistry and expert opinion from another laboratory gave a final diagnosis of epithelioid mesothelioma
  • Adjuvant chemotherapy and radiotherapy were deemed not beneficial because the patient was clinically well
  • At five months, PET-CT showed increased FDG uptake in the right atrium, likely due to residual or recurrent disease
  • At seven months, a CT of the chest and abdomen showed disease recurrence at the anterior/inferior pericardium and pleural-based nodules suspicious for metastasis
  • Nine months after surgery the patient was alive with good performance status (stated in the article's abstract)
• The authors' conclusion: The authors concluded that pericardial mesothelioma is rare and difficult to diagnose, and that immunohistochemistry and expert opinion should be sought when the diagnosis is uncertain. In their view surgery in this case offered symptomatic relief and prognostic benefit, but the role of surgery remains palliative and should be balanced against the risks of surgery itself.

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, Pericardial, Mesothelioma, Prognosis, Overall Survival, Autopsy, Performance Status.

Related studies

• Surgical pathology of primary cardiac and pericardial tumors — C. Basso, M. Valente, et al. (1997)
• Treatment and Outcomes of Primary Pericardial Mesothelioma: A Contemporary Review of 103 Published Cases — E. McGehee, D.E. Gerber, et al. (2019)
• Primary pericardial mesothelioma: a case report of a patient treated with an immune checkpoint inhibitor as the second-line treatment — O. Arponen, V. Salo, et al. (2021)
• Primary pericardial tumors — C.S. Restrepo, D. Vargas, et al. (2013)
• 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)

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