Malignant Pericardial Mesothelioma. Report of two Cases, Review of the Literature and Differential Diagnosis

Abstract

Malignant pericardial mesothelioma is an uncommon variety of a primary malignant cardio-pericardial tumor and it is a highly lethal and fortunately rare cardiac neoplasm. The presentation of pericardial mesothelioma is aspecific and pathologically mesothelioma is not the most common among primary tumors of the pericardium. It is characterized by atypical solid growth of mesothelium with formation of atypical cavities surrounded by fibrous stroma. Antemortem diagnosis is difficult and distant metastases are extremely rare. Radical surgery can be used to treat localized mesothelioma. The treatment for advanced primary pericardial mesothelioma is usually palliative because the tumor is resistant to radiotherapy and chemotherapy. The prognosis is unfavorable. The median survival from the onset of symptoms is six months. In this paper we report two cases of patients with primary mesothelioma of the pericardium without a definite history of asbestos exposure.

Positive response of a primary malignant pericardial mesothelioma to pemetrexed plus cisplatin followed by pemetrexed maintenance chemotherapy: A case report

“…In those cases, complete surgical resection is not possible. In addition, distant metastases in the lung or liver are observed in 25-45% of cases (13,14). Patients with distant metastasis, such as the present case, and patients who are not candidates for surgery should be administered chemotherapy (11,14).…”

“…For such cases, systemic chemotherapy is important (11,14). However, there are currently no existing standard chemotherapeutic drugs or treatment strategies, and as a result overall prognosis remains poor at ~6 months (2,4,5,11,13). The present study reports the case of a patient diagnosed with PMPM with accompanying lung metastasis.…”

“…As a result, surgical resection combined with radiotherapy or chemotherapy is required in cases of localized tumors (11,12). In addition, numerous patients diagnosed with PMPM have accompanying distant metastasis (13,14). For such cases, systemic chemotherapy is important (11,14).…”

Primary pericardial malignant mesothelioma: A rare but aggressive disease

“…Although there are reports suggesting radiation therapy as a causal factor for pericardial mesothelioma, etiology of the disease still remains unclear [6]. Exposure to asbestos has been related to the development of pleural mesothelioma, but, there seems to be no evidence to support a link between exposure and the development of pericardial mesothelioma [5,7]. The case being presented had a history of living in an area where soil was contaminated asbestos, but, there was no finding suggestive of asbestosis in pathology.…”

Primary Malignant Pericardial Mesothelioma

“…One of the largest autopsy series including about 500,000 cases gave an incidence of primary pericardial tumours of <0.0022% (Gossinger et al, 1998). However, it accounts for approximately 2-3% of all cardiac and pericardial primary tumours being the third tumour after angiosarcoma and rhabdomiosarcoma (Karadzic et al, 2005;Papi et al, 2005).…”