Unveiling the mystery: a rare case of localized malignant pericardial mesothelioma-case report

Our plain-English summary of Unveiling the mystery: a rare case of localized malignant pericardial mesothelioma-case report, by Y. Zhang, M. Pang (Frontiers in Oncology, 2024).

The study

• Authors: Y. Zhang, M. Pang
• Journal: Frontiers in Oncology
• Published: 2024;14:1342748
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary malignant pericardial mesothelioma (PMPM) is a rare pericardial malignant tumor. Most manifestations of PMPM are localized or diffuse masses surrounding the heart. The prognosis of diffuse PMPM is poor due to the difficulty of surgical resection. Although the edge of localized PMPM is clear and can be easily resected, the diagnosis of this disease is difficult. Timely diagnosis and proper treatment are key to a good prognosis. Here, we report a patient with localized PMPM and describe the method for the diagnosis of this disease.

Copyright © 2024 Zhang and Pang.

In plain English

This was a case report from The First People's Hospital of Yunnan Province in Kunming, China, about one 53-year-old woman with localized primary malignant pericardial mesothelioma, a cancer of the sac around the heart. The article did not say whether she had any asbestos exposure. In 2021 a heart ultrasound found fluid around the heart. A local hospital suspected tuberculosis and gave tuberculosis treatment, but the fluid increased. At the authors' hospital, blood tests, tumor markers and tuberculosis tests were normal. A first fluid sample showed a small number of atypical cells, and a PET-CT scan showed no signs of a malignant tumor. A contrast heart MRI showed thickened pericardium with delayed enhancement. Fluid was then drained for 24 hours, and its sediment was set in wax blocks and stained. The results suggested malignant mesothelioma. The patient refused chemotherapy and, as of September 30, 2023, had no spread to other body parts. The authors concluded that this localized form is easily missed and that special fluid-collection and pathology methods are needed.

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 53-year-old female patient with pericardial effusions, seen at The First People's Hospital of Yunnan Province, Kunming, China, in 2021, with follow-up to September 30, 2023
• Exposure: Not reported. The article does not describe this patient's occupational history or whether the patient had any asbestos exposure.
• Main results:
  • An echocardiogram on February 10, 2021 at a local hospital found a pericardial effusion, with the thickest part about 4.8 cm. The local hospital suspected pulmonary tuberculosis and gave tuberculosis chemotherapy. After a month the effusion had significantly increased.
  • In this patient, routine blood tests, troponin T, Pro-BNP and tumor markers were normal, and tuberculosis tests showed no abnormalities.
  • Pathological examination of the first pericardial fluid sample showed many red blood cells and a small number of atypical cells.
  • PET-CT showed no signs of malignant tumor, only slight pericardial thickening and adhesion with a small amount of encapsulated effusion.
  • Late gadolinium enhancement cardiac MRI showed that the thickened pericardium had delayed enhancement.
  • After 24-hour drainage of pericardial fluid, the sediment was set in wax blocks and stained (for example CK7, WT-1, CR, CK5/6 and CA125 positive; TTF-1, CDX-2, ER and PR negative). The authors reported that these results suggested malignant mesothelioma.
  • The patient refused chemotherapy. At follow-up on September 30, 2023, the patient had stable vital signs and no metastasis.
• The authors' conclusion: The authors concluded that localized pericardial thickening with large pericardial effusions is easily missed and misdiagnosed. In their view, a negative fluid result cannot rule out the disease, and special drainage and pathology methods (such as cell wax blocks with immunostaining), together with imaging, should be used.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Pericardial, Prognosis, Surgical Resection.

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