Clinical pathologic conference

Our plain-English summary of Clinical pathologic conference, by R.N. Schnitzler, J. Cohen, E.O. Lipchik, et al (American Heart Journal, 1972).

The study

• Authors: R.N. Schnitzler, J. Cohen, E.O. Lipchik, E.A. Schenk
• Journal: American Heart Journal
• Published: 1972;84(3):401-8
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This clinical pathologic conference is a teaching case report about one man, a garage worker. He was admitted to hospital in December 1967 with worsening fatigue, cough, breathlessness and ankle swelling. He had smoked two to three packs a day for many years. The article does not mention asbestos or any other fiber exposure. Chest X-rays and heart catheter studies showed an enlarged heart and a mass in the middle of the chest pressing on the heart and lung vessels. He was readmitted in February 1968 and died on the twentieth hospital day. Before the autopsy, the discussing physician favored a primary tumor of the pericardium, the sac around the heart. At autopsy, a 20 by 17 by 16 cm mass encased the heart. The pathologist diagnosed a fibro-epithelial, or mixed, mesothelioma of the pericardium. It was classified as benign or non-aggressive because it stayed in the pericardial region with minimal infiltration, and it had not spread to lymph nodes or other organs. The pathologist concluded that the tumor caused the heart dysfunction by compressing the heart and the vessels at its base.

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: Clinical pathologic conference (single case report with clinical discussion and autopsy findings)
• Who was studied: One man, a garage worker, admitted to Strong Memorial Hospital, Rochester, N.Y., in December 1967 and readmitted in February 1968; heavy cigarette smoker
• Exposure: The article does not mention asbestos or any fiber exposure. The only occupation given is garage worker. The patient smoked two to three packs of cigarettes daily for many years.
• Main results:
  • Angiography in the patient showed a mediastinal mass compressing the heart chambers and displacing or narrowing pulmonary vessels.
  • The patient deteriorated despite treatment and died on the twentieth day of his second hospital admission.
  • Before the autopsy findings were given, the discussing physician favored a primary pericardial tumor. Speaking statistically, the discussing physician named primary mesothelioma or sarcoma of the pericardium as most likely.
  • At autopsy, a 20 by 17 by 16 cm mass in the mediastinum compressed both lungs. The excised mass weighed 2,820 Gm and encased the heart. The right pleural cavity held 1,500 ml of fluid and the left held 2,700 ml.
  • Under the microscope, the tumor was mostly spindle-shaped cells, with cystic areas lined by epithelial-like cells. Tumor cells infiltrated the epicardium and the outer layer (adventitia) of the large arteries and veins in the upper mediastinum. They did not invade the heart muscle or the blood vessel walls.
  • There were no metastases to lymph nodes or other organs.
  • The tumor was diagnosed as a fibro-epithelial or mixed type of mesothelioma of the pericardium. It was classified as benign or non-aggressive because it remained confined to the pericardial region and its infiltration there was minimal.
  • Staining showed material consistent with an acidic mucopolysaccharide in this pericardial tumor.
• The authors' conclusion: The pathologist concluded that the patient's heart dysfunction was due to the tumor pressing on the heart and the blood vessels at its base. The pathologist found no structural explanation for the suspected mitral valve leak.

Topics

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

Related studies

• Primary pericardial mesothelioma: report of two cases and review of the literature — A.L. Sytman, R.N. MacAlpin (1971)
• Malignancies involving the pericardium — W.H. Warren (2000)
• A Rare Pericardial Malignancy — U. Fatima, S. Gupta, et al. (2016)
• Surgical pathology of primary cardiac and pericardial tumors — C. Basso, M. Valente, et al. (1997)
• Primary tumors and cysts of the heart and pericardium — H.A. McAllister (1979)
• Primary pericardial tumors — C.S. Restrepo, D. Vargas, et al. (2013)

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