Case report: A case of primary cardiac malignant mesothelioma

Our plain-English summary of Case report: A case of primary cardiac malignant mesothelioma, by A. Wang, B. Liu, S. Dong, et al (Frontiers in Oncology, 2024).

The study

• Authors: A. Wang, B. Liu, S. Dong, Y. Wang
• Journal: Frontiers in Oncology
• Published: 2024;14:1356592
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary cardiac malignant tumors are extremely rare, making up about 10% of all primary cardiac tumors. Most of these tumors are primary sarcomas, with primary mesothelioma being even less common. This report details a 53-year-old male patient diagnosed with primary cardiac malignant mesothelioma. The patient had symptoms of chest pain and difficulty breathing. A CT scan showed an enlarged heart, fluid around the heart, and irregular thickening of the pericardium. Diagnosis was confirmed through a surgical biopsy, which showed the presence of malignant mesothelioma. After the procedure, the patient received appropriate cardiac support. Although stable at discharge, the patient unfortunately died three months later due to severe wheezing. There may be a potential link between exposure to radioactive iodine treatment and this outcome. This case highlights the diagnostic and treatment challenges of primary cardiac malignant tumors and reminds physicians to consider this rare disease when evaluating patients with similar symptoms.

Copyright © 2024 Wang, Liu, Dong and Wang.

In plain English

This was a case report of one patient, a 53-year-old man treated at Binzhou Medical University Hospital in China, who was diagnosed with primary cardiac malignant mesothelioma, a rare cancer involving the heart. He had had chest tightness and wheezing for one year. He had a history of hyperthyroidism treated with medicines and two courses of iodine-131 (radioactive iodine) therapy. A chest CT showed an enlarged heart, fluid around the heart and irregular thickening of the pericardium (the sac around the heart). During surgery about 1200 ml of fluid was drained. The whole heart was found wrapped in a rigid mass, so removing the tumor was judged not feasible and only samples were taken. The tissue findings were consistent with epithelioid malignant mesothelioma. He chose to go home and died three months after discharge. The authors wrote that there may be a potential link with the radioactive iodine treatment, and that this disease is easily misdiagnosed. They reported finding no occupational exposures linked to his work as a truck driver. The article does not mention asbestos.

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)
• Who was studied: One 53-year-old man treated at Binzhou Medical University Hospital, Shandong, China. He had chest tightness and wheezing for one year.
• Exposure: History of hyperthyroidism treated with methimazole, propranolol and two courses of iodine-131 (radioactive iodine) therapy. The authors found no occupational exposures related to his job as a truck driver. Asbestos is not mentioned.
• Main results:
  • Chest CT showed an enlarged heart and irregular thickening of the pericardium, with fluid around the heart and around both lungs.
  • About 1200 ml of pale-yellow fluid was drained from around the heart during surgery.
  • The entire heart was enveloped by a rigid mass, and surgical removal of the tumor was judged not feasible. Only parts of the mass and pericardium were removed for examination.
  • Examination of the cardiac mass and the pericardium supported a diagnosis of epithelioid malignant mesothelioma.
  • The heart's pumping measure (ejection fraction) was 42% before surgery and 56% three days after surgery.
  • The patient died three months after discharge, after persistent wheezing.
• The authors' conclusion: The authors suggested there may be a potential link between the patient's radioactive iodine treatment and the outcome. They concluded that primary cardiac malignant mesothelioma is easily misdiagnosed, leading to delayed treatment, because it is rare and lacks specific symptoms.
• Limitations the authors state:
  • For their table of previously reported cases, the authors could not obtain the original records of the 1991 and 1996 cases.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Sarcoma, CT Scan, Pericardium, Biopsy.

Related studies

• Surgical pathology of primary cardiac and pericardial tumors — C. Basso, M. Valente, et al. (1997)
• Primary cardiac tumors: experience at the University of Minnesota — J.E. Molina, J.E. Edwards, et al. (1990)
• Malignant primary cardiac tumors. The Cleveland Clinic experience, 1956 to 1986 — P.A. Bear, D.S. Moodie (1987)
• Primary cardiac lymphoma with unusual presentation: A report of two cases — C.F. Chen, P.P. Hsieh, et al. (2017)
• Cardiac tamponade as the initial manifestation of primary pericardial mesothelioma — M. Stein, A. Neuman, et al. (1995)
• Primary malignant pericardial mesothelioma presenting with cardiac tamponade — S. Matsuyama, T. Imazuru, et al. (2020)

Browse more research in Frontiers in Oncology, or return to medical research.