A case of malignant pericardial mesothelioma with constrictive pericarditis physiology misdiagnosed as pericardial metastatic cancer

Our plain-English summary of A case of malignant pericardial mesothelioma with constrictive pericarditis physiology misdiagnosed as pericardial metastatic cancer, by M.J. Lee, D.H. Kim, J. Kwan, et al (Korean Circulation Journal, 2011).

The study

• Authors: M.J. Lee, D.H. Kim, J. Kwan, K.S. Park, S.H. Shin, S.I. Woo, S.D. Park, W.S. Lee
• Journal: Korean Circulation Journal
• Published: 2011;41(6):338-41
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pericardial mesothelioma is a rare and progressive cardiac tumor. There is no established standard treatment and the prognosis is poor. Most patients were retrospectively diagnosed from surgery or autopsy due to absence of specific clinical manifestation. Most patients with pericardial mesothelioma have demonstrated constrictive physiology on echocardiography or cardiac catheterization. Therefore, pericardial mesothelioma was often misdiagnosed as other causes of constrictive pericarditis. We report a case of primary pericardial mesothelioma misdiagnosed as pericardial metastasis of unknown origin.

In plain English

This case report, from Inha University College of Medicine in Incheon, Korea, described a 59-year-old woman with two months of intermittent shortness of breath and swelling of both legs. Heart ultrasound and cardiac catheterization showed the pattern of constrictive pericarditis, in which the sac around the heart restricts the heart's filling. CT scans showed a thickened pericardium with multiple nodules, fluid around both lungs and in the abdomen, and enlarged lymph nodes, so doctors first suspected cancer that had spread from an unknown source. A first biopsy found no cancer cells, and a PET-CT scan showed active nodules only in the pericardium. Surgery through the breastbone found malignant mesothelioma of the epitheloid type, and she was diagnosed with primary malignant pericardial mesothelioma. After six cycles of pemetrexed and carboplatin chemotherapy, the tumor volume on CT was similar, and she was alive 8 months after diagnosis. The authors concluded that clinical suspicion is the most important factor for correct diagnosis and early detection. The report did not mention asbestos or any other exposure.

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 patient: a 59-year-old woman with a two-month history of intermittent shortness of breath and swelling of both lower legs, seen at Inha University College of Medicine, Incheon, Korea. No dates of care are given.
• Main results:
  • Cardiac catheterization in the patient showed the dip and plateau pattern of constrictive physiology: rapid rising of early diastolic pressures with abrupt equalization in both ventricles. On Doppler echocardiography, peak early diastolic velocity differed by approximately 30% between breathing in and breathing out.
  • The first thoracoscopic pericardial biopsy found no malignant cells.
  • PET-CT showed several hypermetabolic nodules in the pericardium, with a maximum standardized uptake value of 6.18. Significant uptake was restricted to the pericardium.
  • Tissue removed at pericardiectomy through a sternotomy showed malignant mesothelioma of the epitheloid type. Staining was positive for calretinin and D2-40 and negative for CEA and TTF-1. The patient was diagnosed with primary malignant pericardial mesothelioma.
  • After six cycles of pemetrexed and carboplatin chemotherapy, repeat CT showed similar cancer volume. The patient was alive 8 months after diagnosis and was on conservative management.
• The authors' conclusion: The authors concluded that primary pericardial malignant mesothelioma is extremely rare, has no established treatment when advanced, and is often misdiagnosed as another cause of constrictive pericarditis. In their view, clinical suspicion is the most important factor for correct diagnosis and early detection.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Pericardial, Prognosis, Autopsy, Metastasis.

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