Three-year survival after surgery for primary malignant pericardial mesothelioma: report of a case

Our plain-English summary of Three-year survival after surgery for primary malignant pericardial mesothelioma: report of a case, by K. Fujita, M. Hata, A. Sezai, et al (Surgery Today, 2014).

The study

• Authors: K. Fujita, M. Hata, A. Sezai, K. Minami
• Journal: Surgery Today
• Published: 2014;44(5):948-51
• Type of article: Case report
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 59-year-old female underwent surgery for a primary malignant pericardial mesothelioma. She presented with progressive dyspnea, and several imaging studies demonstrated a 65 × 22 mm tumor in the aortopulmonary window, accompanied by massive pericardial effusion. The tumor was successfully excised with clean surgical margins under cardiopulmonary bypass, followed by patch reconstruction of the pulmonary artery, and was diagnosed as an epithelioid type of malignant pericardial mesothelioma. The patient tolerated the operation and subsequent adjuvant chemotherapy without any complications. She remained alive and asymptomatic for almost 3 years after surgery, despite the fact that the median survival of this disease is 6-10 months. This patient is the second longest postoperative survivor of this extremely rare, aggressive neoplasm.

In plain English

This case report described one patient, a 59-year-old previously healthy woman treated at a hospital in Japan. The authors stated she had no exposure to asbestos. She had worsening shortness of breath and repeated large build-ups of fluid around the heart. Imaging showed a tumor on the main pulmonary artery, outside the heart itself. Surgeons removed the tumor using a heart-lung machine, took part of the pulmonary artery wall with it, and repaired the gap with a patch of horse pericardium. The pericardium (the sac around the heart) was left in place. Tissue tests diagnosed primary malignant pericardial mesothelioma of the epithelioid subtype. She then had two cycles of chemotherapy with cisplatin and pemetrexed without complications. No recurrence was found until 3 years after surgery. At that point the tumor had returned locally and spread to the lungs and liver, although she still had no symptoms. The authors stated that the effect of the chemotherapy could not be judged. They concluded that early and complete surgical removal can offer hope for survival, at least when this tumor is localized.

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 59-year-old previously healthy woman with recurrent massive pericardial effusion, referred to a cardiovascular surgery department in Japan
• Exposure: None. The authors report the patient had no exposure to asbestos.
• Main results:
  • The tumor was located outside the cardiac structures and was removed under cardiopulmonary bypass together with part of the pulmonary artery wall. The defect was repaired with an equine pericardial patch.
  • The pericardium appeared intact and was left in place.
  • The diagnosis was primary malignant pericardial mesothelioma of the epithelioid subtype.
  • After apparently complete excision, the patient received two cycles of adjuvant chemotherapy (cisplatin 75 mg/m2, pemetrexed 500 mg/m2) without complications.
  • No recurrence was found until 3 years after surgery. At that point local recurrence and lung and liver metastases were detected, while the patient remained without symptoms.
• The authors' conclusion: The authors concluded that their experience suggests early and complete surgical excision can provide hope for survival, at least in localized primary malignant pericardial mesothelioma.
• Limitations the authors state:
  • The effect of the adjuvant chemotherapy could not be judged, because no tumor tissue was detected before it was given.
  • The pericardium was not removed, and the authors note the outcome might have differed if it had been.
  • Because the disease is so rare, the prognosis with standard therapies is unclear.

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, Dyspnea, Pericardial Effusion, Epithelioid, Chemotherapy, Median Survival, Neoplasm.

Related studies

• Pericardial Mesothelioma in a 35-Year-Old Male With Ulcerative Colitis — J. Iliff, N.K. Bart, et al. (2019)
• 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)
• Sarcomatoid Type Primary Pericardial Mesothelioma with a Long-term Survival after the Onset of Cardiac Tamponade — C. Saisho, H. Ishii, et al. (2016)
• Primary pericardial mesothelioma in a 19-year-old presenting as pericarditis — M.O. Kayatta, S.P. Dineen, et al. (2013)
• Recurrence of Pericardial Mesothelioma Affecting the Myocardium After Pericardial Resection — M. Rodríguez, H.R. Mallidi, et al. (2018)
• Cardiac tamponade as the initial manifestation of primary pericardial mesothelioma — M. Stein, A. Neuman, et al. (1995)

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