Malignant pleural mesothelioma with constrictive pericarditis as the first manifestation: A case report

Our plain-English summary of Malignant pleural mesothelioma with constrictive pericarditis as the first manifestation: A case report, by C.P. He, D.W. Tu, T.W. Zhang, et al (Clinical Case Reports, 2023).

The study

• Authors: C.P. He, D.W. Tu, T.W. Zhang, Q. Zhang, Q. Zhang, D. Kang, Y.Y. Wang, Y.Y. Li, B. Zhang, S.S. Han, H.B. Li
• Journal: Clinical Case Reports
• Published: 2023;11(6):e7555
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Pleural mesothelioma (PM) with pericardial involvement is extremely rare. We now report a rare case of malignant PM with constrictive pericarditis as the first presentation. A 59-year-old male diagnosed with constrictive pericarditis underwent pericardiectomy and pericardial pathology revealed mesothelial hyperplasia. Eight months after surgery, the patient was admitted to the hospital with chest tightness and wheezing for 5 days. Computed tomography scan of the chest showed a left lung expansion insufficiency, limited bilateral pleural thickening, pericardial thickening with a small amount of pericardial effusion, and multiple enlarged lymph nodes in the mediastinum, bilateral supraclavicular fossa, bilateral cervical roots, and right axilla. The pleural malignancy should be possibly considered. Pathology after pleural puncture showed malignant PM. Pathology after left supraclavicular lymph node puncture biopsy showed metastatic malignant mesothelioma. The diagnosis of this patient was clear. Although malignant PM rarely involves the pericardial constriction, we cannot ignore the fact that malignant PM involves the pericardium. The patient has been diagnosed with constrictive pericarditis, accompanied by pleural thickening and pleural effusion. Without other pathogenic factors, pleural biopsy should be aggressively performed in patients with constrictive pericarditis to determine the cause.

© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.

In plain English

This article is a case report of one 59-year-old man treated at a hospital in Binzhou, China. He had smoked for more than 40 years and denied asbestos exposure. At his first admission, scans showed a small left pleural effusion, thickening of the pleura on both sides, and a thickened pericardium. Doctors diagnosed constrictive pericarditis of unknown cause, and he underwent a pericardiectomy. Tissue from the pericardium showed mesothelial hyperplasia. Eight months later he returned with chest tightness and wheezing. A pleural biopsy showed malignant mesothelioma, and a biopsy of a lymph node above the left collarbone showed metastatic malignant mesothelioma. He received pemetrexed, carboplatin and sintilimab, stopped after three cycles, and was in poor condition at telephone follow-up. After a multidisciplinary review, the doctors decided that malignant pleural mesothelioma had caused the constrictive pericarditis. The authors concluded that this cause is easily overlooked. They recommended an early pleural biopsy during surgery for unexplained constrictive pericarditis.

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 59-year-old man, previously healthy, treated at Binzhou Medical College Affiliated Hospital, China; he had smoked for more than 40 years
• Exposure: No asbestos exposure was reported: the patient denied it. He had a smoking history of more than 40 years.
• Main results:
  • At first admission the patient was diagnosed with constrictive pericarditis of unknown cause and had a pericardiectomy on the ninth day after admission
  • Pathology of the removed pericardial tissue showed mesothelial hyperplasia
  • Eight months after surgery, a biopsy of the left pleura showed malignant mesothelioma
  • A needle biopsy of a left supraclavicular lymph node showed metastatic malignant mesothelioma
  • After a multidisciplinary review, the doctors determined that the constrictive pericarditis was caused by malignant pleural mesothelioma
  • The patient stopped treatment (pemetrexed and carboplatin with sintilimab) after three cycles and was in poor condition at telephone follow-up on April 5, 2023
• The authors' conclusion: The authors concluded that pleural mesothelioma can lead to early constrictive pericarditis and is easily overlooked by clinicians. They recommended an early pleural biopsy at the time of surgery for unexplained constrictive pericarditis.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pericardial, Pericardiectomy, Pathology, Reactive Mesothelial Hyperplasia, Bilateral, Pleural Thickening, Pericardial Effusion.

Related studies

• 18F-FDG PET/CT Revealing Constrictive Pericarditis as the Only Manifestation of Malignant Mesothelioma — J.P. Edel, H. Balink (2019)
• Primary malignant pericardial mesothelioma - a rare cause of pericardial effusion and consecutive constrictive pericarditis: a case report — T. Butz, L. Faber, et al. (2009)
• Asbestos induced pericardial effusion and constrictive pericarditis — D. Davies, M.I. Andrews, et al. (1991)
• Chronic constrictive pericarditis associated with asbestosis — L. Fischbein, M. Namade, et al. (1988)
• Malignant primary pericardial mesothelioma presenting as effusive constrictive pericarditis: a case report study — A. Savarrakhsh, A. Vakilpour, et al. (2021)
• A case of malignant pericardial mesothelioma with constrictive pericarditis physiology misdiagnosed as pericardial metastatic cancer — M.J. Lee, D.H. Kim, et al. (2011)

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