A case report of an extremely rare and aggressive tumor: primary malignant pericardial mesothelioma

Our plain-English summary of A case report of an extremely rare and aggressive tumor: primary malignant pericardial mesothelioma, by X. Feng, L. Zhao, G. Han, et al (Rare Tumors, 2012).

The study

• Authors: X. Feng, L. Zhao, G. Han, M. Khalil, F. Green, T. Ogilvie, V. Krause
• Journal: Rare Tumors
• Published: 2012;4(2):e21
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary pericardial malignant mesothelioma (PMPM) is extremely rare with an incidence less than 0.0022%. It comprises 0.7% of all mesothelioma cases. To date, approximately 350 cases of pericardial mesothelioma have been reported in the literature. Its typical presentation is insidious, with nonspecific signs and symptoms, and usually results in constrictive pericarditis, cardiac tamponade and congestive heart failure either by a serous effusion or by direct tumorous constriction of the heart. With the exception of several case reports, the outcome is uniformly fatal, and patients typically die within six months of diagnosis. Here we report a 72-year-old Cauca -sian male with persistent pericardial and pleural effusion. He was diagnosed with PMPM after pericardectomy. He had only one cycle of chemotherapy with cisplatin and pemetrexed. He developed acute kidney injury as result of chemotherapy. He died 1 month after diagnosis and 6 months after the first symptoms.

In plain English

This article is a case report describing one patient at the University of Calgary, Canada. A previously healthy 72-year-old Caucasian man, a life-long non-smoker who had worked as an electronic repairman, was transferred to the authors' hospital in December 2010 with persistent fluid around the heart and lungs. He had no apparent history of occupational or incidental exposure to asbestos. Surgical tissue from the pericardium (the sac around the heart) favored a diagnosis of biphasic primary malignant pericardial mesothelioma. He received one cycle of cisplatin and pemetrexed chemotherapy, developed acute kidney injury, and died 1 month after diagnosis and 6 months after his first symptoms. Autopsy instead showed sarcomatous mesothelioma in the pericardium and pleura, spreading to liver and lymph nodes; the authors said sampling may explain the difference. The authors favored the pericardium as the tumor's origin. A lung asbestos body analysis showed a high normal amount of asbestos bodies, and tests for SV40 virus in pericardial tissue were negative. The authors noted that because of his work he might have had asbestos exposure he was not aware of.

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 of a single patient, including autopsy
• Who was studied: one previously healthy 72-year-old Caucasian man, a life-long non-smoker, transferred to the authors' hospital (University of Calgary, Alberta, Canada) in December 2010; he died in February 2011
• Exposure: no apparent occupational or incidental asbestos exposure reported; he worked as an electronic repairman (called an electrician in the discussion), and the authors suggested he might have had exposure he was unaware of; lung asbestos body analysis was done
• Main results:
  • From the tissue removed at pericardiectomy, a diagnosis of biphasic primary malignant pericardial mesothelioma was favored for this patient
  • After one cycle of cisplatin and pemetrexed, the patient developed acute kidney injury and no further chemotherapy was given
  • The patient died 1 month after diagnosis and 6 months after his first symptoms
  • At autopsy, the tumor in the pericardium and pleura was compatible with sarcomatous mesothelioma, with metastases in the liver and lymph nodes
  • The authors judged at autopsy that the tumor began in the pericardium and extended into the pleura
  • Lung asbestos body analysis (bleach digestion method) showed a high normal amount of asbestos bodies in the patient's lung tissue
  • PCR and immunostaining for SV40 virus on the patient's pericardial tissue were both negative
• The authors' conclusion: The authors considered the tumor likely too advanced to treat, since it involved the pericardium, pleura and liver. They suspected, but could not confirm, that death related to reduced cardiac output caused by the rigid, thickened pericardium.
• Limitations the authors state:
  • The autopsy was limited to chest and abdominal organs by family consent
  • The difference between the biphasic type seen before death and the sarcomatous type seen at autopsy may reflect sampling, since more tissue was examined at autopsy
  • The mechanism of death was unclear

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Pericardial, Mesothelioma, Cardiac Tamponade, Pleural Effusion, Chemotherapy, Cisplatin, Pemetrexed (Alimta).

Related studies

• Primary pericardial mesothelioma: a rare entity — M. Godar, J. Liu, et al. (2013)
• Primary malignant pericardial mesothelioma - a rare cause of pericardial effusion and consecutive constrictive pericarditis: a case report — T. Butz, L. Faber, et al. (2009)
• Primary Pericardial Mesothelioma: A Rare but Serious Consideration — S. Seal, H. Simon (2021)
• A rare case of primary malignant pericardial mesothelioma — R. Ramachandran, P. Radhan, et al. (2014)
• F-18 FDG PET/CT images of a rare primer cardiac tumour: Primary Pericardial Mesothelioma — İ. Ak Sivrikoz, H. Önner, et al. (2016)
• Primary pericardial mesothelioma and asbestos exposure: a rare fatal disease — D.M.M. Freitas, R.L. Ramos, et al. (2017)

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