Case Report: A case of primary pericardial mesothelioma treated with multimodal combined therapy

Our plain-English summary of Case Report: A case of primary pericardial mesothelioma treated with multimodal combined therapy, by J. Gong, X. Wu, J. Wang (Frontiers in Cardiovascular Medicine, 2024).

The study

• Authors: J. Gong, X. Wu, J. Wang
• Journal: Frontiers in Cardiovascular Medicine
• Published: 2024;11:1433668
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Primary pericardial mesothelioma (PMPM) is a rare, aggressive, and lethal form of cancer. Due to its rarity, low incidence and poor prognosis, PMPM has no accepted standard-of-care treatment options with management and outcomes often extrapolated from diffuse pleural mesothelioma. Disease-specific studies are needed to better define PMPM. We report a case of PMPM highlighting the potential role for multimodal combined therapy.

Case Report: The patient is a 62 years old female who had nonspecific syndromes and inconclusive image findings in May 2023. Then monthly follow-up echocardiography was performed. Two months later, cardiac ultrasound showed pericardial fluid. Pericardiocentesis with pericardial drain was performed. The fluid was bloody, cultivations for tuberculosis were negative and cytological analysis of the fluid showed no malignant cells. Positron emission tomography-computed tomography revealed that the lesion was localized at the anterior and left part of the mediastinum without distant metastasis. Followed up a pericardiectomy was operated. The diagnosis of PMPM is determined by pathological and immunohistochemical evaluation of tissue specimens. Postoperative patient experienced chest pain, right shoulder and upper limb swelling and pain. Pain management and anticoagulant therapy were administered. The patient underwent multimodal therapy consisting of surgical resection, six cycles of chemotherapy (carboplatin plus pemetrexed) in combination with pembrolizumab, and sequential adjuvant intensity-modulated radiation therapy, totaling 50 Gy in 25 fractions, as the first-line treatment, resulting in complete relief of symptoms and satisfactory outcomes with no complications. Presently, the tumor is under local control, with no signs of distant metastasis, and maintenance immunotherapy is scheduled. Continued observation is necessary for monitoring subsequent disease progression.

Conclusion: PMPM represents a distinct disease with no universally accepted treatment options. The case suggests that multimodal treatment may improve outcomes in selected patients with PMPM.

© 2024 Gong, Wu and Wang.

In plain English

This case report described one 62-year-old woman in Shanghai, China, with primary pericardial mesothelioma, a cancer of the lining around the heart. She smoked and had no history of occupational asbestos exposure. The authors wrote that the cause of her disease remained unknown. Her illness began in May 2023 with low fever and dry cough, and diagnosis took about three months. After fluid was drained from around her heart, surgeons removed part of the tumor, and tissue tests confirmed epithelioid mesothelioma. Soon after surgery she had chest pain, right arm swelling, and tumor and blood clots in major veins. She then received six cycles of carboplatin and pemetrexed chemotherapy with the immunotherapy drug pembrolizumab, plus radiotherapy (50 Gy in 25 fractions). Her pain eased after the first cycle, and scans showed the mass shrinking. Side effects included grade II bone marrow suppression, fatigue, nausea and vomiting. At the time of writing the tumor was under local control without distant spread. The authors concluded that multimodal treatment may improve outcomes in selected patients, noting that this was a single case needing further observation.

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 62-year-old woman, a smoker, treated at the Department of Radiation Oncology, Shidong Hospital, Shanghai, China. Symptoms began in May 2023 and she presented to the department in September 2023.
• Exposure: No asbestos exposure was reported: the patient had no history of occupational asbestos exposure and denied relevant occupational exposure. The authors stated that the cause of her disease remained unknown.
• Main results:
  • It took three months from the onset of the patient's symptoms to diagnosis.
  • After partial resection of the tumor, immunohistochemical analysis of the tissue confirmed epithelioid mesothelioma.
  • Six days after surgery, a CT scan showed tumor embolus and thrombus formation in the superior vena cava and veins of the right arm and neck. Half a month after surgery she had chest pain and swelling and pain of the right shoulder and upper limb.
  • She received six cycles of pemetrexed 500 mg/m2, carboplatin AUC = 5 and pembrolizumab 200 mg every 3 weeks (September 2023 to January 2024), with radiotherapy to the pericardial lesion of 50 Gy in 25 fractions.
  • Cancer pain subsided after the first cycle of chemotherapy, and painkillers were stopped.
  • The pericardial mass had regressed before the third cycle. A follow-up two months after first-line treatment showed further regression.
  • During systemic treatment the patient had grade II bone marrow suppression, fatigue, nausea, vomiting and gastrointestinal reactions, with no other treatment-related side effects reported.
  • At the time of the report, the tumor was under local control with no signs of distant metastasis, and maintenance immunotherapy was scheduled.
• The authors' conclusion: The authors concluded that primary pericardial mesothelioma has no universally accepted treatment, and that this case suggests multimodal treatment may improve outcomes in selected patients.
• Limitations the authors state:
  • The report is based on a single case, and the authors said further studies are needed in a broader patient population.
  • Long-term outcomes and survival benefits require further observation.
  • Because the patient could not lie flat, no chest CT or heart MR images were obtained before chemotherapy.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Prognosis, Pleural Mesothelioma, Ultrasound, Pericardial, Pericardiocentesis, Mediastinum, Metastasis.

Related studies

• Multimodal Diagnostic Workup of Primary Pericardial Mesothelioma: A Case Report — J. Liu, Z. Wang, et al. (2021)
• Biphasic pleural mesothelioma treated successfully with multimodal therapy: a case report — K. Omura, R. Fukai, et al. (2023)
• Case Report: Tislelizumab combined with bevacizumab in the treatment of primary malignant pericardial mesothelioma — Z. Liu, Y. Yan, et al. (2026)
• A Case Report of Primary Pericardial Malignant Mesothelioma Treated with Pemetrexed and Cisplatin — J.S. Kim, S.Y. Lim, et al. (2017)
• Primary pericardial mesothelioma: a case report of a patient treated with an immune checkpoint inhibitor as the second-line treatment — O. Arponen, V. Salo, et al. (2021)
• Primary pericardial malignant mesothelioma and response to radiation therapy — K.A. Reardon, M.A. Reardon, et al. (2010)

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