Primary Malignant Pericardial Mesothelioma Manifesting as Constrictive Pericarditis with Atypical Imaging Features: A Case Report

Our plain-English summary of Primary Malignant Pericardial Mesothelioma Manifesting as Constrictive Pericarditis with Atypical Imaging Features: A Case Report, by E. Shahverdi, G. Santhosh Kumar, C. Schneider, et al (Research in Heart Yield and Translational Medicine, 2026).

The study

• Authors: E. Shahverdi, G. Santhosh Kumar, C. Schneider, M. Lange
• Journal: Research in Heart Yield and Translational Medicine
• Published: 2026;21(1):98-102
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Primary malignant pericardial mesothelioma (PMPM) is an exceptionally rare and aggressive cancer originating from the mesothelial lining of the heart. This distinct and challenging oncologic entity is typically discovered at an advanced stage due to vague, nonspecific symptoms-most commonly chest pain and dyspnea. These clinical features often mimic more common conditions, making early detection difficult. Diagnostic confirmation usually requires detailed histopathologic analysis, often obtained through surgical procedures or postmortem examination. The disease's elusive nature and rapid progression contribute to its generally poor prognosis, underscoring the need for heightened clinical awareness and advanced diagnostic strategies.

Case Report: A 58-year-old patient was diagnosed with malignant pericardial mesothelioma, which progressed rapidly and resulted in death within 1 month of diagnosis.

Conclusions: PMPM remains a rare and highly aggressive cancer characterized by swift, fatal progression. Diagnosis is difficult because of nonspecific clinical symptoms. Accurate diagnosis is essential for subsequent treatment planning. Nonetheless, limited treatment alternatives, coupled with the minimal effectiveness of immunotherapy in advanced disease, highlight the pressing need for further research and therapeutic advances.

Copyright© 2026 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.

In plain English

This case report described one 58-year-old patient, treated at a cardiology department in Osnabrück, Germany, who had primary malignant mesothelioma of the pericardium, the sac around the heart. The article states the patient had no history of asbestos exposure, radiation therapy or viral infections. The patient had severe shortness of breath, night sweats and unintended weight loss over 3 months. Heart ultrasound and CT scans showed a thickened pericardium (up to 3 cm on CT) and signs of constrictive pericarditis. A repeat CT one week later showed clear tumor growth and spread to lymph nodes. At surgery, a tumor encased the whole heart and invaded the diaphragm and could not be fully removed. Tissue examination confirmed malignant epithelioid mesothelioma of the pericardium. Immunotherapy with nivolumab and ipilimumab was started, and the patient died the following day. The authors concluded that this rare tumor should be considered in recurrent pericardial effusion or constriction, and that the case shows its limited treatment options and poor prognosis.

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 58-year-old patient (sex not stated) seen at the Department of Cardiology, Rhythmology and Intensive Care Medicine, Klinikum Osnabrück, Germany. Dates of care are not given.
• Exposure: No asbestos exposure was reported. The article states the patient had no history of asbestos exposure, radiation therapy or viral infections.
• Main results:
  • The patient presented with severe dyspnea, nocturnal hyperhidrosis (night sweats) and unintentional weight loss over the preceding 3 months. Two years earlier the patient had idiopathic polyserositis, and no malignant cells were found at that time.
  • Echocardiography showed an organized pericardial effusion up to 12 mm, with thickening, adhesion and biatrial enlargement. CT of the thorax showed pericardial thickening up to 3 cm, signs of constrictive pericarditis and pathologic mediastinal lymphadenopathy.
  • A repeat CT 1 week later showed pericardial tumor progression, enlarged cervical, axillary and mediastinal lymph node metastases, and radiologic signs of superior vena cava syndrome.
  • At surgery, a massive tumor was found encasing the entire heart and infiltrating the diaphragm. Complete resection was not possible because of the high risk of fatal hemorrhage.
  • Histology confirmed malignant epithelioid mesothelioma of the pericardium. Immunohistochemistry showed a high-grade diffuse epithelial mesothelioma with 50% solid growth that was positive for pan-cytokeratin AE 1/3, WT-1, D2-40 and calretinin and negative for BerEP4.
  • Immunotherapy with nivolumab and ipilimumab was started, and the patient died the following day.
• The authors' conclusion: The authors concluded that primary malignant pericardial mesothelioma is a rare, sporadic tumor that should be considered in recurrent pericardial effusion or constriction. They said this is especially so in patients unresponsive to pericardiocentesis or with unexplained superior vena cava thrombosis. They stated that the case emphasizes the limited treatment options and poor prognosis of this disease.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Dyspnea, Prognosis, Immunotherapy.

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