A rare case of primary malignant pericardial mesothelioma

Our plain-English summary of A rare case of primary malignant pericardial mesothelioma, by R. Ramachandran, P. Radhan, R. Santosham, et al (Journal of Clinical Imaging Science, 2014).

The study

• Authors: R. Ramachandran, P. Radhan, R. Santosham, S. Rajendiran
• Journal: Journal of Clinical Imaging Science
• Published: 2014;4:47
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary malignant pericardial mesothelioma (PMPM) is a rare tumor of the pericardium. The cause of this tumor is unknown and it has a very poor prognosis. Exposure to asbestos is correlated with the onset of pleural and peritoneal mesothelioma; however, the role of asbestos in pericardial mesothelioma is unclear. Here we highlight the radiological features of this rare tumor and its correlative pathological confirmation with the help of new immunohistochemical (IHC) markers.

In plain English

This was a case report about one 55-year-old woman with primary malignant pericardial mesothelioma, a cancer of the sac around the heart. The patient, a homemaker with no history of asbestos exposure, had breathing difficulty. CT showed irregular pericardial thickening up to 15 mm, pericardial fluid collections, enlarged chest lymph nodes (largest 11.5 mm), and fluid around both lungs without enhancing pleural nodules. Fluid drained from the pericardium and around the lungs, for treatment and diagnosis, showed malignant cells only in the pericardial fluid. PET/CT showed active uptake in the pericardial thickening and chest lymph nodes. A CT-guided biopsy showed tumor cells positive for WT1 and p63 and negative for TTF1. The authors wrote that this, with the imaging, confirmed the diagnosis. As background, the authors wrote that asbestos is linked to pleural and peritoneal mesothelioma, but its role in pericardial mesothelioma is unclear. The authors concluded that careful clinical, radiological and pathological correlation is needed to diagnose this rare tumor. The article did not report any later cancer treatment or the patient's outcome.

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 (single patient), with radiologic-pathologic correlation
• Who was studied: One 55-year-old woman who came to an emergency department with breathing difficulty. The authors are from the Department of Radiology, Sri Ramachandra University, Chennai, India. No dates of care are given.
• Exposure: None reported. The patient was a homemaker with no history of asbestos exposure.
• Main results:
  • Contrast CT of the patient's chest showed enhancing irregular lobular thickening of the pericardium (maximum thickness 15 mm) and fluid collections within the pericardial sleeves.
  • CT showed multiple enlarged chest lymph nodes, the largest measuring 11.5 mm.
  • CT showed moderate pleural effusions on both sides with no enhancing pleural nodules.
  • Pericardial and pleural fluid was drained for both treatment and diagnosis.
  • Malignant cells were found in fluid drawn from the pericardium but not in fluid drawn from the pleura.
  • FDG-PET/CT showed metabolically active uptake in the pericardial thickening (SUV 5 g/ml) and in mediastinal lymph nodes (SUV 4.6 g/ml).
  • On routine staining, the biopsy showed gland formation with occasional papillary processes. The authors found this hard to diagnose definitely without immunohistochemistry.
  • On immunohistochemistry, tumor cells were positive for WT1 and p63 and negative for TTF1. The authors stated that this, with the radiological features, confirmed primary malignant mesothelioma of the pericardium.
  • Background statement by the authors, not a finding of this case: asbestos exposure is correlated with pleural and peritoneal mesothelioma, but its role in pericardial mesothelioma is unclear.
• The authors' conclusion: The authors concluded that careful clinical, radiological and pathological correlation is extremely necessary for diagnosing this very rare tumor.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Pericardium, Prognosis, Peritoneal Mesothelioma.

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