The Antemortem Diagnosis of Primary Malignant Pericardial Mesothelioma: A Multidisciplinary Evaluation

Our plain-English summary of The Antemortem Diagnosis of Primary Malignant Pericardial Mesothelioma: A Multidisciplinary Evaluation, by K. Shikano, S. Hirano, T. Hiroishi, et al (Internal Medicine, 2018).

The study

• Authors: K. Shikano, S. Hirano, T. Hiroishi, N. Hayama, T. Fujita, H. Amano, M. Nakamura, S. Nakamura, H. Tabeta, S. Ichinose, O. Uchida, S. Shimizu
• Journal: Internal Medicine
• Published: 2018;57(17):2559-2562
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 64-year-old woman complaining of progressive dyspnea was admitted with recurrence of massive pericardial effusion. The patient had been diagnosed with radiation pericarditis based on a previous case of pericardiocentesis. To make a diagnosis and improve her symptoms, imaging examinations and pericardial fenestration were performed. Because of difficulty making a diagnosis, after some months, pericardiotomy and incision of the epicardium were performed. The patient was ultimately diagnosed with primary malignant pericardial mesothelioma of the epithelioid type. Primary malignant pericardial mesothelioma is a rare tumor that is difficult to diagnose. An antemortem diagnosis can be made by a multidisciplinary evaluation.

In plain English

This was a case report from Funabashi Municipal Medical Center, Japan, about one patient with primary malignant pericardial mesothelioma, a cancer of the sac around the heart. A 64-year-old woman with worsening shortness of breath was admitted in December 2014. She had been treated for tuberculosis and had radiation therapy for right breast cancer in 1988. She had no history of smoking or asbestos exposure. In 2011 she had come to the hospital with fluid around her heart. Tests on that fluid were not conclusive, and she was diagnosed with radiation pericarditis. A keyhole operation to take a sample of the heart sac showed chronic inflammation, but no definite diagnosis. The fluid came back, and a larger operation in April 2015 gave tissue that led to a diagnosis of the epithelioid type of pericardial mesothelioma. She received palliative care, not chemotherapy, and died. At autopsy the tumor was found mainly in the pericardium, invading the heart muscle, ascending aorta, right pleura and right lung. The authors concluded that she was diagnosed before death through a multidisciplinary evaluation including imaging and surgical biopsies.

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 (single patient)
• Who was studied: One 64-year-old woman admitted with progressive shortness of breath to Funabashi Municipal Medical Center, Japan, in December 2014; history of tuberculosis treatment and radiation therapy for right breast cancer in 1988
• Exposure: The patient had no history of smoking or asbestos exposure; she had received radiation therapy for right breast cancer in 1988
• Main results:
  • In 2011 the patient had presented to the hospital with pericardial effusion, and the fluid had been drained several times
  • Tests on that pericardial fluid gave cytology class III and a negative PCR for tuberculosis; she was diagnosed with radiation pericarditis
  • Tissue from video-assisted thoracoscopic pericardial fenestration showed chronic epicarditis with reactive mesothelial proliferation, without a definitive diagnosis
  • Tissue from pericardiotomy and incision of the epicardium (April 2015) stained positive for calretinin, D2-40 and cytokeratin 5/6 and negative for carcinoembryonic antigen, BerEP4 and thyroid transcription factor 1
  • The patient was diagnosed with the epithelioid type of primary malignant pericardial mesothelioma
  • The patient received palliative care, not chemotherapy, and died; an autopsy was performed
  • At autopsy, malignant cells grew mainly in the pericardium, invading the myocardium, ascending aorta, right pleura and right lung; no other distant metastases were found
• The authors' conclusion: The authors concluded that their patient was diagnosed before death by a multidisciplinary evaluation including diagnostic imaging and surgical biopsies, and that such an evaluation is likely to allow diagnosis before death

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, Pericardiocentesis, Pericardial, Epithelioid.

Related studies

• Primary malignant pericardial mesothelioma: a case report — S.B. Farhat, M. Salah, et al. (2020)
• Primary pericardial mesothelioma in a 19-year-old presenting as pericarditis — M.O. Kayatta, S.P. Dineen, et al. (2013)
• Timely diagnosis of primary pericardial mesothelioma — H.C. Chen, S. Chang, et al. (2020)
• Three-year survival after surgery for primary malignant pericardial mesothelioma: report of a case — K. Fujita, M. Hata, et al. (2014)
• Primary pericardial mesothelioma: report of two cases and review of the literature — A.L. Sytman, R.N. MacAlpin (1971)
• Primary malignant pericardial sarcomatoid mesothelioma: An autopsy report — H. Muta, Y. Sugita, et al. (2017)

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