A middle-aged woman with a heavy heart

Our plain-English summary of A middle-aged woman with a heavy heart, by C. Van de Bruaene, L. Crapé, V. Surmont (Heart, 2017).

The study

• Authors: C. Van de Bruaene, L. Crapé, V. Surmont
• Journal: Heart
• Published: 2017;103(13):1053
• Type of article: Case report
• Read it: PubMed · Publisher

In plain English

This is a case report about one patient at Ghent University Hospital in Belgium, published as an 'image challenge' quiz. A 51-year-old woman who worked as a cleaning woman and did not smoke had four months of worsening breathlessness on exertion, chest heaviness, dry cough, weight loss and tiredness. She had had an Epstein-Barr virus infection two months before her symptoms began. Fluid around her heart (pericardial effusion) came back after it was drained, and imaging found a mass in the sac around the heart (the pericardium). CT showed the mass encasing structures in the middle of the chest. A PET scan showed tracer uptake in the thickened pericardium, with an SUVmax of 22.32. Tissue staining confirmed primary malignant pericardial mesothelioma, epithelioid type. The tumour was judged unresectable. She received palliative platin/pemetrexed chemotherapy, which was stopped because of toxicity, and she was discharged with comfort care. The article does not say whether she was exposed to asbestos. Citing earlier work, the authors wrote that a relation between this tumour and asbestos exposure has not yet been confirmed.

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 (image challenge quiz) of a single patient
• Who was studied: one 51-year-old woman, a cleaning woman and non-smoker, referred to Ghent University Hospital, Belgium; the article does not give the dates of her care
• Exposure: The article does not describe any asbestos exposure for this patient. It reports only that she worked as a cleaning woman and had an Epstein-Barr virus infection 2 months before symptom onset.
• Main results:
  • After earlier drainage of fluid around the heart at another hospital, repeat echocardiography at the authors' hospital showed the pericardial effusion had returned, with diastolic dysfunction and a pericardial mass.
  • The PET scan showed tracer uptake in the thickened pericardium with SUVmax 22.32, which the authors described as indicating a hypermetabolic character.
  • Immunohistochemistry was positive for calretinin, WT-1, cytokeratin 5, epithelial membrane antigen and p53, and negative for thyroid transcription factor-1 and carcinoembryonic antigen. This confirmed primary malignant pericardial mesothelioma (epithelioid) and excluded adenocarcinoma.
  • During her hospital stay, cardiac monitoring showed new-onset paroxysmal atrial fibrillation.
  • The tumour was considered unresectable because of its local extent and infiltration, and the patient received first-line platin/pemetrexed chemotherapy as palliative treatment.
  • Chemotherapy was stopped because of toxicity, and the patient was discharged with comfort care.
• The authors' conclusion: The authors gave primary malignant pericardial mesothelioma as the correct diagnosis (answer E), confirmed by histopathology and immunohistochemistry of a biopsy.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Related studies

• Primary tumors and cysts of the heart and pericardium — H.A. McAllister (1979)
• Occupational class, occupational mobility and cancer incidence among middle-aged men and women: a prospective study of the French GAZEL cohort* — M. Melchior, M. Goldberg, et al. (2005)
• Successful palliation for an aged patient with primary pericardial mesothelioma — R. Isoda, H. Yamane, et al. (2015)
• A Rare Pericardial Malignancy — U. Fatima, S. Gupta, et al. (2016)
• Unusual primary tumors of the heart — T.J. Vander Salm (2000)
• Synovial sarcoma of the heart arising from a so-called mesothelioma of the atrio-ventricular node — E.A. Sheffield, B. Corrin, et al. (1988)

Browse return to medical research.