18F‑fluorodeoxyglucose imaging of primary malignant pericardial mesothelioma with concurrent pericardial and pleural effusions and bone metastasis: A case report

Abstract

Primary malignant pericardial mesothelioma (PMPM) is an aggressive tumor that originates from the mesothelial cells of the pericardium. PMPM with extensive atrial infiltration and bone metastasis is extremely rare. The diagnosis and staging of PMPM based on anatomical imaging may be difficult when concurrent pericardial and pleural effusions are present. A 28-year-old man presented with progressive chest pain. Concurrent pericardial and pleural effusions were identified on computed tomography. On echocardiography, mild thickening and adhesions of the pericardium with the right ventricle and atrium were observed. 18F-fluorodeoxyglucose (FDG) metabolism imaging revealed increased accumulation in the pericardium and adjacent right atrium. Ring-shaped radioactivity aggregation and bone destruction in the sacrum were demonstrated on 18F-FDG and 99mTc-methyl diphosphonate imaging. The diagnosis of PMPM was subsequently confirmed by pathology. The patient survived for >1.5 years with comprehensive treatment.

Case Report: Early diagnosis and bevacizumab-based chemotherapy for primary pericardial mesothelioma: a case with occupational asbestos exposure history

“…However, in a review of 103 published PPM cases, it was found that chemotherapy, but not surgery, provided a statistically significant survival benefit. Of note, a doublet regimen, cisplatin plus pemetrexed, was used as the first-line treatment in almost all reported cases with chemotherapy ( 6 , 7 , 9 – 11 , 17 , 18 , 20 , 21 ). In only one reported case ( 14 ), a combination of bevacizumab, cisplatin, and pemetrexed was used as the first-line treatment for PPM, but unfortunately, the tumor remained stable after eight cycles of chemotherapy.…”

“…So far, there is no consensus on the treatment of PPM, although the survival benefit of chemotherapy has been shown to be superior to that of surgery ( 6 ). In almost all reported cases with chemotherapy, a doublet regimen, cisplatin plus pemetrexed, was used as the first-line treatment ( 6 , 7 , 9 – 11 , 17 , 18 , 20 , 21 ). Here we present a case of early diagnosis of PPM promoted by the indication of the patient's occupational asbestos exposure history and clinical presentations.…”

“…Primary pericardial mesothelioma (PPM) is an exceedingly rare malignant cancer accounting for only 0.7% of all malignant mesotheliomas, with an annual standardized incidence rate of approximately 0.36 per 10 million person-years (1)(2)(3)(4)(5). PPM has a poor prognosis with a median survival of less than six months (1,(4)(5)(6), which has been partly attributed to its frequently delayed diagnosis (6)(7)(8). In many PPM cases, the time from presentation to definite diagnosis may last for several months (4)(5)(6)(7) or even over one year (6,(9)(10)(11)(12)(13)(14).…”

“…PPM has a poor prognosis with a median survival of less than six months (1,(4)(5)(6), which has been partly attributed to its frequently delayed diagnosis (6)(7)(8). In many PPM cases, the time from presentation to definite diagnosis may last for several months (4)(5)(6)(7) or even over one year (6,(9)(10)(11)(12)(13)(14). This slow recognition is likely due to its nonspecific syndromes, its similar presentation to benign pericardial diseases, and its non-definitive etiology (1,(6)(7)(8)(10)(11)(12)(13)(14)(15).…”

“…In many PPM cases, the time from presentation to definite diagnosis may last for several months (4)(5)(6)(7) or even over one year (6,(9)(10)(11)(12)(13)(14). This slow recognition is likely due to its nonspecific syndromes, its similar presentation to benign pericardial diseases, and its non-definitive etiology (1,(6)(7)(8)(10)(11)(12)(13)(14)(15). It has been suggested that early detection of this disease is the only hope for survival (2).…”