Pericardial mesothelioma mimicking mediastinal lymphoma and systemic rheumatic disease: a case report

Our plain-English summary of Pericardial mesothelioma mimicking mediastinal lymphoma and systemic rheumatic disease: a case report, by G. Hirnle, M. Kapałka, M. Krawiec, et al (Frontiers in Oncology, 2024).

The study

• Authors: G. Hirnle, M. Kapałka, M. Krawiec, T. Hrapkowicz
• Journal: Frontiers in Oncology
• Published: 2024;14:1481373
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Pericardial mesothelioma is an exceedingly rare pericardial neoplasm. It has atypical clinical symptoms and imaging characteristics that often lead to an inconclusive diagnosis. The diagnosis of a rare tumor such as pericardial mesothelioma, which can present with a variety of manifestations, requires a multidisciplinary approach.

Case Presentation: A 36-year-old Caucasian female patient without significant past medical history was admitted to the hospital with chest pain and a high fever and was diagnosed with acute pericarditis. The following month, the patient was treated for sepsis; during this hospitalization, lab tests for antinuclear antibodies (ANA) turned out to be positive. Concurrently, mediastinal lymphadenopathy was observed. Given the suspicion of mediastinal lymphoma, a mediastinoscopy with lymph node biopsy was performed. Following a negative biopsy result, positron emission tomography combined with computed tomography (PET/CT) and blood immunophenotyping were performed. Both tests ruled out a diagnosis of lymphoma. Concurrently, the patient was hospitalized in the rheumatology department due to positive ANA results. There, in addition to the ANA titer at a level of 1:320, lupus anticoagulant was detected. The patient was diagnosed with systemic lupus erythematosus (SLE) and initiated on chronic steroid therapy. As heart failure progressed, the patient was admitted to the cardiology department. Tissue Doppler echocardiography and cardiac magnetic resonance imaging (MRI) revealed features indicative of constrictive pericarditis. The patient underwent a pericardiectomy with satisfactory results. However, the pathology result of the pericardium remained equivocal. The patient was readmitted 3 months later with severe circulatory failure, and a salvage procedure of pericardiectomy was performed. Histopathological examination of the sections confirmed the diagnosis of pericardial epithelioid mesothelioma. The patient died after 3 weeks of palliative care.

Conclusions: In the differential diagnosis of relapsing and resultant constrictive pericarditis, neoplastic processes that may mimic systemic rheumatic diseases should also be considered. Pericardial mesothelioma is a very rare diagnosis and may result in increased ANA titers, particularly anti-dense fine speckled 70 (DFS70) antibodies.

Copyright © 2025 Hirnle, Kapałka, Krawiec and Hrapkowicz.

In plain English

This case report described one patient, a 36-year-old woman, whose pericardial mesothelioma (a cancer of the lining around the heart) was diagnosed only after months of other suspected diagnoses. The patient first had acute pericarditis with fluid around the heart. Enlarged lymph nodes in the chest led doctors to suspect mediastinal lymphoma. A lymph node biopsy showed only reactive changes, and a PET/CT scan and blood testing ruled lymphoma out. Positive antinuclear antibodies (ANA, at 1:320 and later 1:3,200) and lupus anticoagulant led to a diagnosis of systemic lupus erythematosus and steroid treatment. On later re-evaluation the patient no longer met the criteria for active disease. Heart scans showed constrictive pericarditis. Tissue removed during a first operation to remove the pericardium was inconclusive. Three months later a repeat emergency operation was done, and its tissue showed pericardial epithelioid mesothelioma. The patient reported no history of asbestos exposure and died after 3 weeks of palliative care. The authors concluded that unexplained findings in recurrent pericarditis should prompt review by a multidisciplinary team.

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 36-year-old female patient, described by authors from the Medical University of Silesia, Poland; dates not given
• Exposure: No asbestos exposure was reported by the patient; no fiber type or job is described
• Main results:
  • Mediastinal lymph node biopsy, done because mediastinal lymphoma was suspected, showed only reactive lesions
  • A PET/CT scan ruled out lymphoma
  • On PET/CT, uptake in the pericardial sac (SUVmax 8.7) was interpreted as inflammation
  • Lupus anticoagulant was found alongside positive ANA, and the patient was diagnosed with systemic lupus erythematosus
  • The patient's ANA titer rose to 1:3,200
  • On re-evaluation, the patient no longer met criteria for active SLE
  • Heart imaging showed features of constrictive pericarditis
  • Tissue from the first pericardiectomy was inconclusive
  • Tissue from the repeat pericardiectomy, done 3 months later, showed pericardial epithelioid mesothelioma
  • The patient died after 3 weeks of palliative care
• The authors' conclusion: The authors concluded that, in recurrent effusive or constrictive pericarditis without a convincing cause, unexplained laboratory or imaging abnormalities should prompt review by a multidisciplinary team.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Pericardial, Neoplasm, Multidisciplinary Team, Lymphadenopathy, Mediastinoscopy, Biopsy, Pericardiectomy.

Related studies

• A second case of pericardial mesothelioma mimicking systemic lupus erythematosus in the literature in over 30 years: a case report — C. Mensi, A. Romano, et al. (2017)
• Primary pleural epithelioid hemangioendothelioma mimicking as a posterior mediastinal tumor — J. Wethasinghe, J. Sood, et al. (2015)
• Localized malignant pleural mesothelioma mimicking an anterior mediastinal tumor — T. Hino, T. Kamitani, et al. (2019)
• Diagnosis and treatment of pericardial mesothelioma by mediastinal mass resection: a case report — L. Liang, X. Zhang, et al. (2022)
• Pleural involvement of diffuse large B-cell lymphoma mimicking malignant pleural mesothelioma — T. Ito, K. Fujita, et al. (2020)
• Prognostic Factors and Survival in Pericardial Mesothelioma: A Systematic Review and Quantitative Analysis — M. Kapałka, E. Pazek, et al. (2026)

Browse more research in Frontiers in Oncology, or return to medical research.