Rare Primary Pericardial Mesothelioma on an \[18F\]FDG PET/CT Scan and Its Postchemotherapy Response Evaluation

Our plain-English summary of Rare Primary Pericardial Mesothelioma on an [18F]FDG PET/CT Scan and Its Postchemotherapy Response Evaluation, by H. Rathore (Indian Journal of Nuclear Medicine, 2024).

The study

• Author: H. Rathore
• Journal: Indian Journal of Nuclear Medicine
• Published: 2024;39(4):313-315
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Primary pericardial mesothelioma is a highly aggressive and rare neoplasm that arises from the pericardial mesothelial cell and has a poor prognosis. The diagnosis is usually established by histological and immunohistochemical studies. Malignant mesothelioma most frequently occurs from the pleura (90%), less frequently from the peritoneum and pericardium (6%-10%), and very rarely from the tunica vaginalis in the testis. Most of the patients were retrospectively diagnosed after surgery or an autopsy due to the absence of specific clinical manifestations. We present a case study of a 65-year-old female with primary pericardial mesotheliomas who was investigated with 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG PET/CT) scan for biopsy and staging, which shows significant resolution of disease on postchemotherapy response evaluation and underwent pericardiectomy with a progression-free survival of over 12 months.

Copyright: © 2024 Indian Journal of Nuclear Medicine.

In plain English

This case report described one 65-year-old woman with primary pericardial mesothelioma, a cancer of the lining around the heart, reported from a nuclear medicine department in Mumbai, India. She had had breathlessness and chest pain for 3 months. The article did not mention asbestos or any work history, and it called the disease one of unknown cause. Fluid drained from around her heart contained atypical malignant cells. An FDG PET/CT scan showed active thickening of the pericardium, up to about 1.5 cm, and active lymph nodes. The scan guided a CT biopsy, which showed mesothelioma, mainly of epithelioid type. She received eight cycles of bevacizumab and carboplatin, and her symptoms eased after two cycles. A repeat scan after 7 months showed the thickening reduced to 4 to 5 mm, the fluid gone and no new lesion. She then had her pericardium removed without complications and was advised four more cycles. She was alive after 12 months. The author concluded that FDG PET/CT has a promising role in diagnosis, staging, biopsy targeting, judging treatment response and surgical planning.

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 65-year-old woman with shortness of breath (NYHA grade III), occasional orthopnea and chest pain for 3 months. She was investigated in the Department of Nuclear Medicine and PET CT, Bombay Hospital and Medical Research Centre, Mumbai, India. Dates of care are not given.
• Exposure: No asbestos or other exposure is reported. The only history given is that there was no other significant medical or surgical history, and the author describes the disease as of unknown etiology.
• Main results:
  • Before treatment, the FDG PET/CT showed diffuse plaque-like and nodular pericardial thickening, up to about 1.5 cm along the right atrium, with a maximum standardized uptake value (SUVmax, a measure of tracer uptake) of 21.9. It also showed mild plaque-like pericardial calcification and metabolically active mediastinal lymph nodes; the larger right paracardiac node measured about 2.2 cm by 0.9 cm, with SUVmax 9.9.
  • The CT-guided biopsy showed pleomorphic malignant mesothelioma cells, predominantly epithelioid type. Immunohistochemical staining was positive for vimentin, calretinin, CK7 and D2-40, and negative for CEA, TTF-1, PLAP, CD30 and CD117.
  • The patient was diagnosed with primary malignant pericardial mesothelioma because the pericardium was the only lesion seen on the scan and there was no evidence of a primary cancer in other organs.
  • The patient received eight cycles of bevacizumab 400 mg and carboplatin 450 mg. Symptom relief was observed after two cycles.
  • A repeat FDG PET/CT after 7 months showed significant resolution of the pericardial thickening, with a mild residual area along the right atrium of 4 to 5 mm maximum thickness and SUVmax 5. The pericardial effusion had resolved completely, the lymph nodes had regressed with complete resolution of metabolic activity, and there was no new lesion.
  • The patient then underwent complete pericardiectomy through sternotomy, with no intraoperative or postoperative complications, and was advised four more cycles of the same chemotherapy. The patient was alive after 12 months and on regular follow-up.
• The authors' conclusion: The author concluded that, as a whole-body scan, 18F-FDG PET/CT has a promising role in accurate diagnosis and staging, in targeting the biopsy site, in evaluating response after chemotherapy, and in surgical planning for primary pericardial mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, CT Scan, Neoplasm, Pericardial, Mesothelial Cells, Prognosis, Mesothelioma, Pleura.

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• Primary pericardial mesothelioma: a rare entity — M. Godar, J. Liu, et al. (2013)
• Primary malignant pericardial mesothelioma - a rare cause of pericardial effusion and consecutive constrictive pericarditis: a case report — T. Butz, L. Faber, et al. (2009)
• A case report of an extremely rare and aggressive tumor: primary malignant pericardial mesothelioma — X. Feng, L. Zhao, et al. (2012)
• Primary Pericardial Mesothelioma: A Rare but Serious Consideration — S. Seal, H. Simon (2021)
• A rare case of primary malignant pericardial mesothelioma — R. Ramachandran, P. Radhan, et al. (2014)
• Primary pericardial mesothelioma and asbestos exposure: a rare fatal disease — D.M.M. Freitas, R.L. Ramos, et al. (2017)

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