Sudden cardiac death due to primary malignant pericardial mesothelioma: Brief report and literature review

Our plain-English summary of Sudden cardiac death due to primary malignant pericardial mesothelioma: Brief report and literature review, by R. Martínez-Girón, L. Pantanowitz, S. Martínez-Torre, et al (Respiratory Medicine Case Reports, 2019).

The study

• Authors: R. Martínez-Girón, L. Pantanowitz, S. Martínez-Torre, J. Pantanowitz
• Journal: Respiratory Medicine Case Reports
• Published: 2019;26:185-188
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Sudden cardiac death is an unexpected clinical condition that typically occurs due to a cardiac cause, generally within 1 h of symptom onset, in people with known or unknown cardiac disease. Primary malignant pericardial mesothelioma, as a cause of sudden death, is an uncommon consequence of a rare disease. Herein, we present a case of cardiac tamponade due to a primary pericardial mesothelioma. Cytological, histopathology and gross post-mortem findings, in a previously asymptomatic 46-old-year man, are reported. The medical literature regarding this topic is also reviewed.

In plain English

This article was a case report with a brief review of earlier published cases. It described a 46-year-old man who worked for a building demolition company and was brought unconscious to an emergency room with suspected cardiac arrest. The text said significant occupational exposure to asbestos was unknown, while the authors' table listed possible occupational exposure to asbestos. A heart ultrasound showed a large fluid build-up around the heart that was pressing on it (cardiac tamponade). Draining it removed 800 ml of bloody fluid, but he died. Autopsy, tissue and fluid tests led to a diagnosis of primary malignant pericardial mesothelioma of the epithelioid type. The tumour was confined to the pericardium, with shallow spread into the heart muscle. His lungs and pleura were healthy, and no asbestos bodies were seen. A search of PubMed and EMBASE found 269 reported cases of this cancer. Of these, 37 involved tamponade and only three others ended in sudden cardiac death. The authors described theirs as a fourth such case. They recommended testing the fluid for cancer cells in all patients presenting with tamponade, even when cancer is not suspected.

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, including autopsy) with a brief literature review of published cases of primary malignant pericardial mesothelioma
• Who was studied: One 46-year-old man, a worker in a building demolition company, admitted unconscious to an emergency room with suspected cardiac arrest (location of the case not stated; authors are from Spain and the USA)
• Exposure: Work in building demolition. The case text states that significant occupational asbestos exposure was unknown. The authors' Table 1 lists the risk factor as possible occupational exposure to asbestos. No fiber type is given.
• Main results:
  • In this patient, echocardiography showed a large pericardial effusion with cardiac tamponade.
  • In this patient, pericardiocentesis yielded 800 ml of haemorrhagic fluid. He died despite emergency support.
  • At autopsy, the mesothelioma had not spread to adjacent structures, and the patient's lungs and pleura were healthy. The pericardium was thickened, with superficial infiltration of the tumour into the heart muscle.
  • Tissue sections showed diffuse infiltration of the pericardium by epithelioid malignant mesothelial cells. No asbestos bodies were observed.
  • The tumour cells were positive for pan-cytokeratin, EMA and calretinin and negative for CEA and TTF-1, which the authors said supports the diagnosis of mesothelioma.
  • The pericardial fluid was hypercellular, with abundant malignant mesothelial cells that were calretinin positive.
  • The literature search found 269 reported cases of primary malignant pericardial mesothelioma. Of these, 37 were associated with cardiac tamponade, and only three other patients had sudden cardiac death.
  • In the authors' comparison table, average age was 40,5 years (range 27 to 46) for the 4 tamponade cases with sudden cardiac death, including this case. It was 52,6 years (range 17 to 85) for the 34 tamponade cases without sudden cardiac death.
  • In the same table, asbestos exposure was listed for 2 of the 4 cases with sudden cardiac death (this case included) and 12 of the 34 cases without. Post-irradiation was listed for two cases in the group without sudden cardiac death.
• The authors' conclusion: The authors concluded that this was a fourth case in which primary malignant pericardial mesothelioma contributed to sudden cardiac death. They recommended cytological analysis of the fluid in all patients who present with cardiac tamponade, even if malignancy is not initially suspected.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Cardiac Tamponade, Histopathology.

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• Cisplatin-induced sudden cardiac death with hemodynamic collapse: a severe adverse drug reaction: Case report — S. Abramavicius, M. Zemaitis, et al. (2017)
• Primary mesothelioma of atrioventricular node: cause of sudden death — E.H. Hemsted (1986)
• Surgical pathology of primary cardiac and pericardial tumors — C. Basso, M. Valente, et al. (1997)
• Cardiac tamponade as the initial manifestation of primary pericardial mesothelioma — M. Stein, A. Neuman, et al. (1995)
• Primary malignant pericardial mesothelioma presenting with cardiac tamponade — S. Matsuyama, T. Imazuru, et al. (2020)

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