Multimodal Diagnostic Workup of Primary Pericardial Mesothelioma: A Case Report

Our plain-English summary of Multimodal Diagnostic Workup of Primary Pericardial Mesothelioma: A Case Report, by J. Liu, Z. Wang, Y. Yang, et al (Frontiers in Cardiovascular Medicine, 2021).

The study

• Authors: J. Liu, Z. Wang, Y. Yang, Y. Xiong, W. Wang, J. Qiu, K. Zhao, B. Zheng
• Journal: Frontiers in Cardiovascular Medicine
• Published: 2021;8:758988
• 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 is an extremely rare tumor, and early identification and accurate diagnosis may improve its clinical outcome. Case presentation: In this study, we reported a case of a 70-year-old woman who presented with dyspnea. Conventional transthoracic echocardiography showed massive pericardial effusion. Contrast-enhanced ultrasonography revealed a hyper-enhancing mass in the pericardium. Further imaging methods, including cardiac MRI and positron emission tomography/computed tomography, showed invasion of the pericardial mass into the adjacent tissues and distant metastases. Pathologic examination of a puncture biopsy specimen finally confirmed the diagnosis of PPM. Conclusion: Pericardial masses are difficult to detect when a large amount of pericardial effusion is present and the mass is small. The combination of multiple modalities plays a meaningful role in identifying PPM.

Copyright © 2021 Liu, Wang, Yang, Xiong, Wang, Qiu, Zhao and Zheng.

In plain English

This article was a case report from Peking University First Hospital in Beijing, China. It described one 70-year-old woman with primary pericardial mesothelioma, a cancer of the lining around the heart. The article did not mention asbestos or any other exposure. In July 2020 she was admitted to a local hospital with worsening shortness of breath, and ultrasound showed a large amount of fluid around the heart. A PET scan there showed intense uptake in the pericardium, and the matching CT images showed a 1.7 by 1.2 cm mass. A biopsy was read as mesothelial cell hyperplasia, and she was sent home without a definite diagnosis. Three months later, at the authors' hospital, ultrasound showed a 75 by 30 mm mass, contrast ultrasound showed it was hyper-enhanced, and cardiac MRI showed invasion into the pericardium and vessels. Biopsy cells were positive for mesothelial markers, and she was diagnosed with epithelioid mesothelioma of the pericardium. The cancer was judged inoperable. She did not receive chemotherapy and died nearly 2 months after diagnosis. The authors concluded that using several diagnostic methods together helps identify this tumor.

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 (one patient)
• Who was studied: One 70-year-old woman, first admitted to a local hospital in July 2020 and then referred 3 months later to Peking University First Hospital, Beijing, China
• Exposure: Not reported. The article does not mention asbestos, occupation, or any other exposure, and states only that the patient had no medical history.
• Main results:
  • At the local hospital, PET showed intense FDG uptake in the pericardium (maximum standardized uptake value 9.6), the area around the left atrium, and the mediastinum.
  • The local hospital's pericardial biopsy was diagnosed as mesothelial cell hyperplasia, not cancer.
  • At the authors' hospital, ultrasound (TTE) showed a pericardial mass measuring 75 by 30 mm.
  • On contrast-enhanced ultrasonography, the mass was hyper-enhanced compared with the adjacent heart muscle.
  • Cardiac MRI showed the mass attached to the wall of the left atrium, with invasion to the pericardium and vessels.
  • Biopsy cells were positive for the mesothelial markers calretinin and D2-40, CDKN2A (p16) deletion was detected, and the patient was diagnosed with epithelioid mesothelioma of the pericardium.
  • The cancer was judged inoperable because of invasion and metastasis. Chemotherapy was not given because the patient could not tolerate its side effects, and she died nearly 2 months after diagnosis.
• The authors' conclusion: The authors concluded that this case shows the value of using multiple methods (ultrasound, contrast ultrasound, CT, cardiac MRI, PET/CT, and biopsy) to diagnose primary pericardial mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Dyspnea, Pericardial Effusion, Pericardium, Pericardial, Biopsy.

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• Diagnostic Imaging and workup of Malignant Pleural Mesothelioma — L. Cardinale, F. Ardissone, et al. (2017)
• From Ascites to Malignant Peritoneal Mesothelioma: The Diagnostic Workup of a Rare Tumor — M. Nastasi, C. Ferrante, et al. (2026)
• Acute popliteal thrombus workup leads to discovery of primary peritoneal mesothelioma in the absence of any known asbestos exposure — S.T. Ahmed, M. Barvo, et al. (2020)
• Primary pericardial mesothelioma: a rare entity — M. Godar, J. Liu, et al. (2013)

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