Diagnosis and treatment of pericardial mesothelioma by mediastinal mass resection: a case report

Our plain-English summary of Diagnosis and treatment of pericardial mesothelioma by mediastinal mass resection: a case report, by L. Liang, X. Zhang, X. Ke, et al (Annals of Translational Medicine, 2022).

The study

• Authors: L. Liang, X. Zhang, X. Ke, Y. Song, L. Brcic, J.W. Neal, G. Xu, C. Chen
• Journal: Annals of Translational Medicine
• Published: 2022;10(24):1407
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pericardial mesothelioma (PeM) is a rare disease with non-specific symptoms at the onset, because of its rarity, the relevant literature is limited to case reports and small case series, with no cases exceeding 100 in more than 20 years. As the most common initial symptoms are chest tightness and shortness of breath, early diagnosis is difficult, and the beginning of treatment is easily delayed. We present a rare case of difficult-to-diagnose PeM in which the diagnosis was clarified by surgery and the patient achieved a long survival, providing clinicians with our experience in treating this disease at an early stage of diagnosis and early treatment.

Case Description: A 65-year-old female patient attended Affiliated Hospital of Zunyi Medical University, complaining about chest tightness and shortness of breath after activity for the last 2 months, accompanied by edema of the lower limbs in last month. A well circumscribed anterior-mediastinal, partially cystic mass was observed on the chest computed tomography. The patient's heart was compressed by the mass, and the patient had cardiac tamponade symptoms. Cardiac ultrasound showed the enlargement of the right heart, a widened pulmonary artery, pulmonary hypertension, and severe tricuspid regurgitation. The nature of the mass could not be determined prior to the surgery. Anterior superior mediastinal tumour resection and partial pericardial resection and closed thoracic drainage in a median open chest were performed, and pathohistological analysis revealed localized pericardial, epithelioid mesothelioma. In a follow-up after 19 months patient was generally well and without specific discomfort.

Conclusions: Differential diagnosis of the anterior mediastinal mass is broad. In patients with a mediastinal tumour who have significant symptoms, are difficult to diagnose and can tolerate surgery, the thoracic surgeon can use surgery as early as possible to make a definitive diagnosis, save the patient's life, and/or improve the patient's quality of life, experienced pathologist is essential to make fast and correct diagnosis.

2022 Annals of Translational Medicine. All rights reserved.

In plain English

This was a case report of one patient with pericardial mesothelioma, a rare cancer of the lining around the heart. A 65-year-old woman came to a hospital in Zunyi, China, in May 2021 with two months of chest tightness and breathlessness after activity, and swollen legs. A CT scan showed a 13×12×7 cm mass in the front of the chest pressing on her heart. No biopsy could be taken beforehand, so surgeons removed the tumor, which was growing from the pericardium toward the heart muscle. A rapid test during surgery favored adenocarcinoma, but final tissue and staining tests identified epithelioid mesothelioma. She left hospital 19 days after surgery, and CT scans 4 and 19 months after discharge found no significant abnormality. She declined recommended chemotherapy for financial reasons. The article did not describe any asbestos exposure for her. The authors concluded that suspected pericardial mesothelioma needs tissue analysis including immunohistochemistry to confirm the diagnosis.

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), followed by short expert commentary
• Who was studied: One 65-year-old female patient treated at Affiliated Hospital of Zunyi Medical University, China, from May 2021
• Exposure: Not reported. The article does not describe any asbestos or other exposure history for this patient; asbestos is mentioned only in general background.
• Main results:
  • Before surgery, CT showed a partly cystic, partly solid mass in the anterior mediastinum measuring 13×12×7 cm.
  • Cardiac ultrasound showed an enlarged right heart, a widened pulmonary artery, pulmonary hypertension and severe tricuspid regurgitation.
  • A preoperative biopsy could not be obtained because of the small volume of pericardial fluid and the patient's inability to lie flat.
  • During surgery the tumor was found infiltrating and growing from the pericardium towards the myocardium; blood loss was about 800 mL.
  • The intraoperative frozen section favored adenocarcinoma, and histology initially suggested a yolk sac tumor. Immunohistochemistry (keratin, calretinin, cytokeratin 5/6, WT-1, D2-40 positive; Ki-67 10%) led to a diagnosis of pericardial epithelioid mesothelioma.
  • The patient was discharged on the 19th postoperative day. CT scans at the 4th and 19th month after discharge showed no significant abnormality.
  • Chemotherapy was recommended after discharge, but the patient refused further treatment for financial reasons.
• The authors' conclusion: The authors concluded that, where pericardial mesothelioma is clinically suspected, pathological analysis that includes immunohistochemistry is required to confirm the diagnosis. They also stated that this patient's survival so far exceeded previous reports.
• Limitations the authors state:
  • The authors state that the choice of treatment was subject to selection bias and that the patient refused further treatment because of finances.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Cardiac Tamponade, Ultrasound, Pulmonary Hypertension, Pericardial, Epithelioid, Mesothelioma, Differential Diagnosis.

Related studies

• Rosai-Dorfman disease presenting as a solitary mediastinal mass — A.I. Hida, S. Yagi, et al. (2009)
• An unusual cause of an anterior mediastinal mass — I. Hassan, A. Goolam-Mahomed (2014)
• Incidental Finding of Giant Pericardial Lipoma in a Patient Referred for Rectal Bleeding. Differential Diagnosis and Treatment — S. Campana, F. Ferrentino, et al. (2025)
• Pericardial mesothelioma mimicking mediastinal lymphoma and systemic rheumatic disease: a case report — G. Hirnle, M. Kapałka, et al. (2024)
• Primary malignant pericardial mesothelioma with increased serum mesothelin diagnosed by surgical pericardial resection: A case report — T. Kurosawa, K. Sugino, et al. (2016)
• Recurrence of Pericardial Mesothelioma Affecting the Myocardium After Pericardial Resection — M. Rodríguez, H.R. Mallidi, et al. (2018)

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