A Case Report of Primary Pericardial Malignant Mesothelioma Treated with Pemetrexed and Cisplatin

Abstract

Primary pericardial malignant mesothelioma (PPM) is a very rare malignancy, with an incidence of less than 0.002% and represents less than 5% of all mesotheliomas. The cause of pericardial mesothelioma is uncertain that differ from pleural mesothelioma which is associated with asbestos exposure. This malignancy is terribly aggressive and has very poor prognosis with less than six months of overall survival. We present a case of a 71-year-old woman who was diagnosed with cardiac tamponade caused by PPM and received chemotherapy with pemetrexed and cisplatin for six months. During two years she was alive without disease progression. To better understand the clinical, pathologic features and treatment outcome of this entity, we reviewed 23 cases described in the English literature from 2009, together with our case, provided a total of 24 cases. Based on this review, we suggest that PPM must be considered in patients who have unexplained massive pericardial effusion and recommend chemotherapy with pemetrexed and cisplatin for the better outcome of PPM.

Malignant primary pericardial mesothelioma presenting as effusive constrictive pericarditis: a case report study

“…PPM is known to be a highly lethal and metastatic disease owing to late presentation and poor response to treatment. The diagnosis of pericardial mesothelioma is usually late and at the end stages of the disease via surgery or autopsy [ 3 , 4 , 9 ]. Laboratory information is an integral part of the diagnosis, prognosis, and treatment of the disease.…”

“…A palliative strategy based on radiotherapy, chemotherapy, and surgery is widely used [ 4 , 6 , 15 ]. Recently, a combination chemotherapy regimen using different agents has been told to be possibly effective [ 9 ], for instance; according to some previous studies, chemotherapy using pemetrexed (a synthetic pyrimidine-based antifolate) with platin compounds such as cisplatin or carboplatin has shown to be effective in improving patient's survival time, but the results were not as impressive as in pleural mesothelioma [ 3 , 9 , 16 ].…”

“…Among cardiac tumors, primary neoplasms arising from pericardium with the estimated prevalence of 0.001–0.007% are exceptionally infrequent [ 2 ]. Meanwhile, Primary pericardial mesothelioma (PPM) with a prevalence rate of less than 0.002% is known as a rare malignancy [ 3 ]. Malignant mesothelioma is a neoplasm arising from the mesothelial surface within cavities such as plural cavity, peritoneum, and rarely pericardium and tunica vaginalis testis [ 4 ].…”

Sudden cardiac death due to primary malignant pericardial mesothelioma: Brief report and literature review

“…The diagnosis of PMPM has typically been made at the time of post-mortem examination. There are only limited reports that describe the histological and cytological findings of PMPM [[17], [18], [19], [20], [21]].…”

Diagnostic challenges of pericardial mesothelioma: A case report and review of literature

“…1 Patients with PPMM present with non-speci c symptoms, which include fatigue, general weakness, and dyspnea. 2 Being a rare malignancy with non-speci c presenting symptoms, most cases of PPMM are typically diagnosed at an advanced stage or during autopsy. Currently, there is no consensus on optimal treatment for PPMM.…”