Primary malignant pericardial mesothelioma - a rare cause of pericardial effusion and consecutive constrictive pericarditis: a case report

Our plain-English summary of Primary malignant pericardial mesothelioma - a rare cause of pericardial effusion and consecutive constrictive pericarditis: a case report, by T. Butz, L. Faber, C. Langer, et al (Journal of Medical Case Reports, 2009).

The study

• Authors: T. Butz, L. Faber, C. Langer, J. Körfer, O. Lindner, A. Tannapfel, K.M. Müller, A. Meissner, G. Plehn, H.J. Trappe, D. Horstkotte, C. Piper
• Journal: Journal of Medical Case Reports
• Published: 2009;3:9256
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Primary malignant pericardial mesothelioma is a very rare pericardial tumor of unknown etiology.

Case Presentation: A 61-year-old Caucasian woman was admitted to our hospital complaining of exertional dyspnea due to a large pericardial effusion. Intrapericardial fluid volume declined after repeated pericardiocentesis, but the patient progressively developed a hemodynamically relevant pericardial constriction. Pericardiectomy revealed a pericardial mesothelioma. Subsequently, four cycles of chemotherapy (dosage according to recently published trials) were administered. The patient remained asymptomatic, and there was no recurrence of the tumor after three years.

Conclusion: Pericardial mesothelioma should be considered and managed appropriately in non-responders to pericardiocentesis, and in patients who develop constrictive pericarditis late in their clinical course.

In plain English

This was a case report about one patient, a 61-year-old Caucasian woman who was short of breath on exertion and had chest pain. Doctors found a large collection of fluid around her heart. Draining it removed 1500 ml of fluid that contained no cells and no infection. The fluid came back three months later. Repeated drainage reduced it, and testing of the fluid showed signs of chronic infection but no cancerous mesothelial cells. She then developed constriction of the heart lining (constrictive pericarditis). Tissue removed at surgery showed primary malignant pericardial mesothelioma. It was considered primary because no signs of a pleural mesothelioma were found. After further surgery she received four cycles of pemetrexed and cisplatin and went into remission, with no recurrence over the next three years. The authors noted that she had a history of asbestos exposure at work in a school building. They also stated that no definite proven link between asbestos exposure and pericardial disease has yet been shown. The authors concluded that this cancer should be considered when drainage does not work or constriction develops late.

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 61-year-old Caucasian woman admitted to the authors' hospital (the authors are affiliated with Ruhr-University Bochum hospitals in Germany)
• Exposure: History of asbestos exposure at work; she worked in a school building. Fiber type and dose were not reported.
• Main results:
  • The first drainage of the pericardial fluid removed 1500 ml of acellular, sterile fluid, and her symptoms were markedly relieved.
  • Testing of the pericardial fluid showed signs of chronic infection but no malignant mesothelial cells.
  • She developed a hemodynamically relevant pericardial constriction. Partial pericardiectomy with histological examination revealed primary malignant pericardial mesothelioma.
  • At surgery the pericardium was 10 mm thick, and there was no indication of tumor spread to adjacent structures.
  • The tumor was considered primary pericardial mesothelioma because no signs of a pleural mesothelioma were found.
  • After four cycles of pemetrexed and cisplatin, remission was achieved, and there was no tumor recurrence during the next three years.
  • The authors stated that no definite proven association between asbestos exposure and pericardial disease has yet been shown.
• The authors' conclusion: The authors concluded that primary malignant pericardial mesothelioma should be considered and managed appropriately in patients who do not respond to pericardiocentesis or a pericardial window, and in patients who develop constrictive pericarditis late in their clinical course.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Pericardial Effusion, Pericardial, Etiology, Dyspnea, Pericardiocentesis, Pericardiectomy, Chemotherapy.

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