Primary malignant pericardial mesothelioma: a case report

Our plain-English summary of Primary malignant pericardial mesothelioma: a case report, by S.B. Farhat, M. Salah, S. Milouchi (The Pan African Medical Journal, 2020).

The study

• Authors: S.B. Farhat, M. Salah, S. Milouchi
• Journal: The Pan African Medical Journal
• Published: 2020;36:375
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Metastases to the heart and pericardium are much more common than primary malignant neoplasms. Primary malignant pericardial mesothelioma is a rare tumor that arises from the mesothelial cells of the pericardium. It is usually characterized by a delayed diagnosis, a low response to treatment, and a poor prognosis with an overall survival up to six months after the onset of symptoms. We report a rare case of a 32-year-old woman with primary pericardial malignant mesothelioma that was diagnosed 4 months after the onset of pericardial effusion as the first clinical manifestation.

Copyright: Sameh Ben Farhat et al.

In plain English

This case report described one patient: a 32-year-old woman treated at a cardiology department in Medenine, Tunisia. She was diagnosed with primary malignant pericardial mesothelioma, a cancer of the lining around the heart. She had no significant past medical history and denied any exposure to asbestos. She was first admitted after 15 days of shortness of breath. Doctors found a mild fluid buildup around the heart, diagnosed acute pericarditis, and discharged her. A month later she returned with chest pain. The fluid had increased, and an inflammation marker (C-reactive protein) was 166 mg/L. Fluid drawn from around the heart showed inflammation but no signs of cancer, and she was treated for suspected tuberculous pericarditis. When her symptoms returned six weeks later, a surgical biopsy confirmed malignant mesothelioma that had invaded the muscle of the heart's right ventricle. She was referred for palliative chemotherapy and radiotherapy. She died of heart failure that did not respond to treatment, 4 months after the diagnosis was confirmed. The authors concluded that cancer should be considered in acute pericarditis, especially when standard treatment fails.

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 (a single patient)
• Who was studied: One 32-year-old woman with no significant past medical history, hospitalized in the Cardiology Department, Habib Bourguiba University Hospital, Medenine, Tunisia. The dates of care are not given.
• Exposure: No asbestos exposure was reported. The patient denied any exposure to asbestos. No fiber type, product or job is described.
• Main results:
  • At first admission she had a 15-day history of shortness of breath. Echocardiography showed a mild pericardial effusion. She was diagnosed with acute pericarditis and discharged with colchicine and ibuprofen.
  • When she was readmitted a month later for chest pain, the pericardial effusion had worsened and her C-reactive protein level was 166 mg/L. A CT scan showed a circumferential pericardial effusion with no pericardial thickening.
  • Cytology of fluid from pericardiocentesis showed subacute inflammation and mesothelial hyperplasia but no signs of malignancy. She was treated for suspected tuberculous pericarditis.
  • Symptoms recurred six weeks later. A thoracoscopic surgical biopsy confirmed malignant mesothelioma with right ventricular myocardial invasion. Tumor cells were strongly positive for WT1 protein and for a marker printed as 'calcretinin'.
  • She was referred for palliative chemotherapy and radiotherapy. She died of refractory heart failure 4 months after the definitive diagnosis.
• The authors' conclusion: The authors concluded that the case highlights the difficulty of diagnosing primary malignant pericardial mesothelioma. In their view, neoplastic causes should be considered in the differential diagnosis of acute pericarditis, especially when it resists conventional therapy.

Topics

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

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Pericardium, Neoplasm, Mesothelial Cells, Prognosis, Overall Survival, Pericardial, Mesothelioma.

Related studies

• Sarcomatoid Type Primary Pericardial Mesothelioma with a Long-term Survival after the Onset of Cardiac Tamponade — C. Saisho, H. Ishii, et al. (2016)
• The Antemortem Diagnosis of Primary Malignant Pericardial Mesothelioma: A Multidisciplinary Evaluation — K. Shikano, S. Hirano, et al. (2018)
• Pericardial mesothelioma masquerading as a benign pericardial effusion — N.L. Coplan, A.J. Kennish, et al. (1984)
• Echocardiographic characteristics of primary malignant pericardial mesothelioma and outcomes analysis: a retrospective study — L. Kong, Z. Li, et al. (2018)
• Successful palliation for an aged patient with primary pericardial mesothelioma — R. Isoda, H. Yamane, et al. (2015)
• Pericardial Mesothelioma in a 35-Year-Old Male With Ulcerative Colitis — J. Iliff, N.K. Bart, et al. (2019)

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