Malignant mesothelioma associated with localized myocardial fibrosis: a case report

Our plain-English summary of Malignant mesothelioma associated with localized myocardial fibrosis: a case report, by K. Vymetalova, P. Tomasov, R. Polasek (BMC Cardiovascular Disorders, 2021).

The study

• Authors: K. Vymetalova, P. Tomasov, R. Polasek
• Journal: BMC Cardiovascular Disorders
• Published: 2021;21(1):282
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Left ventricular dysfunction is a common reason for patients' referral to cardiology departments for examination. Cardiac involvement is one of the possible yet rare presentations of malignant mesothelioma. We present a case of a patient in whom a routine cardiac examination and imaging revealed malignant mesothelioma. We discuss a possible association between a malignant tumor and myocardial scarring and how the oncologic treatment is influenced by concomitant heart failure. This article aims to raise awareness of the importance of multidisciplinary cooperation and thinking beyond the daily routine of our specialty to ensure the quality care of our patients. It also forced us to think about the possible causes of the association between malignant mesothelioma and myocardial fibrosis.

In plain English

This case report described a 45-year-old man referred to a cardiology department in Liberec, Czech Republic, with pleuritic chest pain. Heart imaging showed that the left ventricle was pumping weakly, with an ejection fraction of about 35%. Its lateral wall was 3 mm thin, compared with 12 mm for the septum. Coronary angiography found no significant coronary artery disease. Cardiac magnetic resonance raised suspicion of pleural malignant mesothelioma next to the affected heart muscle. A CT scan and a biopsy of the pleura confirmed the diagnosis. A detailed history found no asbestos or radiation exposure. The man received four cycles of reduced-dose chemotherapy with carboplatin and pemetrexed, followed by extrapleural pneumonectomy. Tumor-free surgical margins meant the authors did not expect direct invasion of the heart muscle, leaving the scarring unexplained. Because of his heart dysfunction, he did not qualify for adjuvant chemotherapy or radiotherapy after surgery. One year after surgery, his ejection fraction was about 20 to 25%. The authors attributed the heart scar to the tumor's closeness to the heart muscle, while acknowledging that the match could be coincidental.

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
• Who was studied: One 45-year-old man referred to the cardiology department of Liberec Regional Hospital, Czech Republic, with pleuritic chest pain
• Exposure: No asbestos or radiation exposure was found on detailed history
• Main results:
  • At first examination, the patient's left ventricular ejection fraction was approximately 35%
  • The lateral wall of the left ventricle was 3 mm thin, compared with the 12 mm interventricular septum
  • Coronary angiography showed no significant coronary artery disease that would explain the findings
  • Cardiac magnetic resonance raised suspicion of pleural malignant mesothelioma adjacent to the affected myocardium, and the diagnosis was confirmed by CT-guided biopsy of the pleura
  • The patient received neoadjuvant chemotherapy with carboplatin and pemetrexed, then underwent extrapleural pneumonectomy
  • Histopathology showed tumor-free margins, so no direct tumor invasion into the myocardium was expected, which left the localized fibrosis of the left ventricle unexplained
  • Because of left ventricular dysfunction, the patient did not qualify for adjuvant chemotherapy or radiotherapy and was recommended for active surveillance
  • One year after surgery, the patient's ejection fraction was approximately 20 to 25%
• The authors' conclusion: The authors attributed the formation of the myocardial scar to the proximity of the malignant mesothelioma to the myocardium, because no tumor invasion was detected
• Limitations the authors state:
  • The authors stated they could not rule out that the match between the tumor's location and the myocardial scar was coincidental

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Fibrosis.

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