Radiation-Associated Mesothelioma With Mixed Constrictive-Restrictive Physiology After Mantle-Field Radiotherapy

Our plain-English summary of Radiation-Associated Mesothelioma With Mixed Constrictive-Restrictive Physiology After Mantle-Field Radiotherapy, by R. Bensaber, J. Serratrice, N.K. Poku (JACC. Case Reports, 2026).

The study

• Authors: R. Bensaber, J. Serratrice, N.K. Poku
• Journal: JACC. Case Reports
• Published: 2026;31(39):109527
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant mesothelioma is a rare late complication of thoracic radiotherapy and may contribute to complex cardiothoracic manifestations decades after treatment.

Case Summary: A 60-year-old woman treated for Hodgkin lymphoma with mantle radiotherapy and chemotherapy more than 40 years earlier presented with recurrent pleuropericarditis, heart failure symptoms, and recurrent pleural and pericardial effusions. Echocardiography and cardiac catheterization suggested constrictive physiology, whereas cardiac magnetic resonance was nondiagnostic. Positron emission tomography-computed tomography showed hypermetabolic pleural, mediastinal, and pericardial lesions. Despite anti-inflammatory therapy and corticosteroids, progressive congestion required near-total pericardiectomy. Histopathology revealed high-grade mesothelioma involving the mediastinum, pericardium, pleura, lungs, and myocardium. Following pericardiectomy, the restrictive component of a mixed constrictive-restrictive physiology became apparent, leading to cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation.

Discussion: Radiation-associated malignant mesothelioma is a rare but challenging late complication of thoracic radiotherapy and may contribute to mixed constrictive-restrictive physiology.

Take-home Message: Survivors of mantle-field radiotherapy for Hodgkin lymphoma remain at risk for both radiation-associated heart disease and secondary malignancies decades after treatment.

Copyright © 2026 The Authors. Published by Elsevier Inc. All rights reserved.

In plain English

This case report from University Hospital Geneva, Switzerland, described one 60-year-old woman. In the 1980s she had been treated for Hodgkin lymphoma with mantle-field radiotherapy and chemotherapy. The article does not say whether she had asbestos exposure. More than 40 years later she developed recurrent pleural and pericardial effusions (fluid around the lungs and heart) and heart-failure symptoms. Tests of the fluid found no infection or malignancy. PET-CT showed lesions suspicious for cancer, but a lymph node biopsy showed no malignancy. Heart ultrasound and catheterization suggested constrictive physiology; corticosteroids helped only temporarily. During near-total removal of the pericardium (the heart's sac), surgeons found extensive fibrotic tissue. Tissue examination showed high-grade mesothelioma involving the mediastinum, pericardium, pleura, lungs and heart muscle. Four days after surgery she went into cardiogenic shock and needed venoarterial ECMO, a heart-lung support machine, for 2 weeks. Because of advanced disease and profound frailty, systemic cancer treatment could not be started, and palliative care was pursued. The authors concluded that radiation-associated mesothelioma can present more than 4 decades after mantle radiotherapy and may contribute to mixed constrictive-restrictive physiology.

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 60-year-old woman referred to the authors' hospital (University Hospital Geneva, Switzerland) after initial care at a regional hospital; the year of presentation is not stated
• Exposure: Mantle-field radiotherapy and chemotherapy (procarbazine, vinblastine and corticosteroids) for Hodgkin lymphoma in the 1980s, more than 4 decades before presentation; the article does not report any asbestos exposure for this patient
• Main results:
  • The first heart ultrasound showed a left ventricular ejection fraction of 65% and a moderate pericardial effusion of 16 mm, without constrictive physiology; a later ultrasound showed findings supporting constrictive physiology
  • Two pericardial fluid samples showed no infection or malignancy, and repeated pleural fluid analyses had negative cytology
  • PET-CT showed lesions suspicious for neoplastic disease, but the lymph node biopsy showed no malignancy
  • Heart catheterization showed a dip-and-plateau pattern and a prominent Y descent after volume loading, supporting early constrictive physiology
  • Corticosteroids gave only temporary improvement
  • Near-total pericardiectomy revealed extensive infiltrative fibrotic tissue in the mediastinum, heart and pleura
  • Histopathology showed high-grade mesothelioma involving the mediastinum, pericardium, pleura, lungs and myocardium
  • Four days after surgery the patient developed severe biventricular dysfunction and cardiogenic shock requiring 2 weeks of VA-ECMO support
  • Because of advanced disease and profound frailty, systemic oncologic treatment could not be started, and palliative management was pursued
• The authors' conclusion: The authors concluded that radiation-associated mesothelioma is a challenging diagnosis that can present more than 4 decades after mantle radiotherapy and may contribute to a mixed constrictive-restrictive physiology
• Limitations the authors state:
  • The patient's exact radiation dose was not available
  • Part of the cardiac magnetic resonance study could not be completed because of the patient's pain

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Chemotherapy, Pericardial Effusion, Pericardial, Pericardiectomy, Histopathology, Mediastinum, Pericardium.

Related studies

• A case of malignant pericardial mesothelioma with constrictive pericarditis physiology misdiagnosed as pericardial metastatic cancer — M.J. Lee, D.H. Kim, et al. (2011)
• Constrictive pericarditis after left extrapleural pneumonectomy and radiotherapy for malignant mesothelioma — E.J. Hickey, A.A. Khan, et al. (2007)
• The schemes, mechanisms and molecular pathway changes of Tumor Treating Fields (TTFields) alone or in combination with radiotherapy and chemotherapy — G. Tanzhu, L. Chen, et al. (2022)
• Localized benign pleural mesothelioma arising in a radiation field — J.K. Hill, R.F. Heitmiller, et al. (1997)
• Mantle wedge infiltrated with saline fluids from dehydration and decarbonation of subducting slab — T. Kawamoto, M. Yoshikawa, et al. (2013)
• Mantle hydration along outer-rise faults inferred from serpentinite permeability — K. Hatakeyama, I. Katayama, et al. (2017)

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