Primary malignant pericardial mesothelioma with a survival of 2.5 years: a case report

Abstract

Background Primary malignant pericardial mesothelioma (PMPM) is a highly malignant tumor originating in the pericardium serosum with clinical manifestations presenting as constrictive pericarditis, with pericardial tamponade and heart failure. Malignant pericardial mesothelioma is rare and has a poor prognosis, with an average survival time of 6–10 months. Case Description Herein, we report the case of a 57-year-old female who developed chest tightness and panic for no obvious reason. She was diagnosed with tuberculous pericarditis via multiple examinations including positron emission tomography/computed tomography (PET/CT), pleural biochemical routine, tuberculin purified protein derivative (PPD) test, T cell spot (T-SPOT) test, and echocardiography, and was experienced intermittent relief after anti-tuberculosis treatment. On 21 July, 2020, pericardiectomy was performed due to poor therapeutic effect, and the postoperative pathological diagnosis was malignant mesothelioma. After discussing treatment plans and considering the prognosis, the patient opted for palliative care. Subsequently, her symptoms gradually worsened, with chest tightness, shortness of breath, palpitations at rest, frequent arrhythmias, heart failure, cardiogenic shock, and multiple plasma chamber effusions. This case showed that the most common misdiagnosis of PMPM is tuberculous pericarditis, which needs to be differentiated from pleural mesothelioma with pericardial metastasis. Conclusions The diagnosis of PMPM is usually made by pathologic surgery or histopathological examination to determine the specific disease location. In addition, pericardiocentesis fluid exfoliation cytology, imaging and echocardiography can assist diagnosis. Due to the lack of effective treatment for PMPM, timely surgery and postoperative adjuvant chemotherapy are needed to improve the quality of life of patients and prolong their survival time.

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

“…The diagnosis of PPM remains challenging, which leads to the situation that the diagnosis is usually made after surgery or at autopsy (2,10,15,18,21). The delayed diagnosis of PPM may be 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). Our patient also initially had nonspecific symptoms and inconclusive image findings.…”

“…It has been suggested that early detection of this disease is the only hope for survival ( 2 ). Unlike pleural mesothelioma, the relationship between PPM and asbestos exposure remains unsettled; some investigators reported an association with asbestos exposure ( 3 , 4 , 16 ), while others reported no or weak correlation ( 6 – 10 , 12 – 15 , 17 – 19 ). 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 ).…”

“…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).…”

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

“…At present, cell wax block diagnosis is the most effective and reliable technique to distinguish benign and malignant effusions. The combination of immunocytochemical staining can help in identifying the primary source, identify the pathological type of the tumor, and further conduct molecular pathological detection, which provides an objective basis for accurate treatment and prognosis of patients and is valuable for extensive clinical promotion ( 8 , 9 ). In summary, localized pericardial thickening and massive pericardial effusions are easily missed and misdiagnosed in patients.…”