Primary Pericardial Mesothelioma: Report of a Patient and Literature Review

Abstract

Primary mesothelioma of the pericardium is a rare tumor and carries a dismal prognosis. This case report presents a 38-year-old man who suffered from recurrent pericardial fluid. Initial symptoms were unspecific, with dry cough and progressing fatigue. Pericardiocentesis was performed, but analyses for malignant cells and tuberculosis were negative. After recurrence a pericardiectomy was planned. At operation, partial resection of tumor tissue surrounding the heart was performed. Histopathologic examination including immunohistochemical staining for calretinin showed a biphasic mesothelioma. During the postoperative period the patient’s condition ameliorated, but symptoms recurred and the patient died 3 months after diagnosis and 15 months after the first symptoms. At autopsy, the pericardium was transformed by the tumor that also expanded into the mediastinum and had set metastases to the liver. A review of 29 cases presented in the recent literature indicates a higher incidence of malignant pericardial mesothelioma among men than women. Median age was 46 (range, 19–76) years. In pleural mesotheliomas, exposure to asbestos is a known risk factor. However, in primary pericardial mesotheliomas the evidence for asbestos as an etiologic factor seems to be less convincing (3 exposed among 14 cases). Symptoms are often unspecific and cytologic examination of pericardial fluid is seldom conclusive (malignant cells demonstrated in 4/17 cases). Partial resection of the tumor can give a period of symptom reduction. Only a few patients have been treated with chemotherapy. Median survival of patients with pericardial mesotheliomas is approximately 6 months.

Case of Primary Pericardial Mesothelioma

“…7 The tumor is usually confined to the pericardium and the surrounding lymph nodes. 8 However, metastatic disease is found in approximately 50% of the cases, most commonly to the lungs.…”

A rare cause of pericardial disease

“…3 It predominantly affects men (3:1), between the fifth and seventh decades of life, although cases have been reported at younger and older ages. 7 Clinical presentation can include the whole spectrum of manifestations of pericardial disease, from the mildest to the final stage of constrictive pericarditis. 8 Pericardial mesothelioma responds poorly to radiotherapy, and while chemotherapy can reduce the tumor mass, only surgical resection is curative in localized forms.…”

Positive response of a primary malignant pericardial mesothelioma to pemetrexed plus cisplatin followed by pemetrexed maintenance chemotherapy: A case report

“…For such cases, systemic chemotherapy is important (11,14). However, there are currently no existing standard chemotherapeutic drugs or treatment strategies, and as a result overall prognosis remains poor at ~6 months (2,4,5,11,13). The present study reports the case of a patient diagnosed with PMPM with accompanying lung metastasis.…”

“…PMPM has been reported predominantly in men compared with women, with 2:1 and 3:1 ratios (2,4). The disease presents with non-specific symptoms, including dyspnea or chest pain (4,5). Initial manifestations, including pericardial effusion or pericardial thickening, frequently result in confusion with pericarditis or heart failure and delay diagnosis (4,6,7).…”

“…The disease presents with non-specific symptoms, including dyspnea or chest pain (4,5). Initial manifestations, including pericardial effusion or pericardial thickening, frequently result in confusion with pericarditis or heart failure and delay diagnosis (4,6,7). Therefore, multi-modal imaging methods, including echocardiography, computed tomography (CT), magnetic resonance imaging (MRI) and 18 F-fluorodeoxyglucose-positron emission tomography, are often required for the diagnosis (8,9).…”