Primary malignant pericardial mesothelioma with increased serum mesothelin diagnosed by surgical pericardial resection: A case report

Abstract

Abstract.A 37-year-old female smoker without a history of exposure to asbestos was referred to our hospital with persistent pericardial effusion. Chest computed tomography imaging examination revealed an irregular thickened pericardium with large amounts of pericardial effusion and a small pleural effusion. Fluorodeoxyglucose (FDG) positron emission tomography imaging demonstrated intrapericardial FDG accumulation. Blood tests revealed an increase in serum mesothelin levels. Examination of a surgically resected specimen revealed a grayish-white thickening of the pericardium, with a straw-colored mucinous pericardial effusion. Histopathological examination confirmed the diagnosis of epithelioid malignant mesothelioma. Although the patient's condition temporarily improved, with decreased levels of serum mesothelin during chemotherapy with carboplatin and pemetrexed, she succumbed to cardiac tamponade 18 months after the initial onset of the symptoms. Primary malignant pericardial mesothelioma (PMPM) is an extremely rare and refractory disorder. Thus, an early definitive diagnosis and timely treatment are crucial for the management of PMPM.

The Antemortem Diagnosis of Primary Malignant Pericardial Mesothelioma: A Multidisciplinary Evaluation

“…Serum mesothelin is considered to be the best biomarker of malignant pleural mesothelioma. Magnetic resonance imaging and fluorodeoxyglucose positron emission tomography scans are helpful for the diagnosis or staging of PMPM ( 8 - 11 ).…”

Pericardial Mesothelioma With Thrombovascular Complications (Case From Practice)

“…Хотя каких-либо специфических биомаркеров ПМТП до настоящего времени не выявлено, в по-следнее время при подозрении рекомендуется ис-следование мезотелина -сывороточного биомар-кера злокачественной мезотелиомы плевры [28], уровень которого коррелирует также с возникно-вением и динамикой ПМТП (повышение уровня при прогрессирующем течении заболевания и вре-менное снижение после хирургического удаления опухоли и начала химиотерапии) [29].…”

“…Лучевая терапия при ПМТП малоэффективна, но может применяться как дополнительное лечение у больных с неполной резекцией ПМТП [30]. И, наконец, так как удлинение жизни описано при применении химиотерапии (комбинации циспла-тина и пеметрекседа) у больных злокачествен-ной мезотелиомой плевры, такое лечение (в том числе с заменой цисплатина на карбоплатин, для уменьшения кардиотоксичности) рассматривает-ся как терапия первой линии при ПМТП, способ-ствующая увеличению продолжительности жиз-ни [1, 2,29].…”

Primary malignant pericardial mesothelioma presenting as constrictive pericarditis with an atypical imaging appearance: a case description

“…Primary malignant pericardial mesothelioma (PMPM) is a rare malignant tumor with a poor prognosis. Its atypical clinical symptoms and imaging characteristics lead to misdiagnoses and inconclusive diagnoses, and its final diagnosis mainly relies on pericardial histopathology, postoperative pathology, or even autopsy results (1)(2)(3). In this article, we report the case a 50-year-old woman with PMPM that atypically presented as constrictive pericarditis to raise awareness of this easily neglected malignant pericardial tumor.…”

“…Indeed, previous studies have reported that it has a misdiagnosis rate of approximately 35%, and it is most commonly misdiagnosed as tuberculous pericarditis (6). Misdiagnoses and inconclusive diagnoses may be made for the following reasons: (I) there are no specific clinical symptoms and imaging findings for some diffuse lesions; (II) the symptoms are relieved by cardiac therapy, diuretics, or pericardiocentesis, which may mask the true conditions of the disease; and (III) a pericardial biopsy is relatively hard to achieve, and pericardial effusion cytology has a low positive rate <30% in the detection of malignant cells (2,3,6).…”