Primary pericardial mesothelioma presenting as constrictive pericarditis

Abstract

Primary pericardial mesothelioma is an extremely rare and lethal cardiac tumor. We report an autopsy case of a primary pericardial mesothelioma in a 52-year-old man. He developed dyspnea, cough, low-grade fever and night sweats approximately 3 months before last admission. Initially, he was evaluated at a hospital in another city, without a firm diagnosis. Due to progressive symptoms and the development of lower-extremity edema, he presented at our hospital in September 2005. The physical examination at admission demonstrated signs of pericardial tamponade. Chest radiography revealed marked enlargement of the cardiac silhouette. Specimens of bloody pericardial fluid were positive for pericardial mesothelioma by cytologic examination. The general condition of the patient worsened very rapidly and he was transferred to the intensive care unit where he later died. Postmortem examination confirmed primary pericardial mesothelioma of the mixed/biphasic type with lymphatic metastasis in the right lung. By using immunohistochemical analysis for specific markers of mesothelioma and for differentiation of the mesothelioma from the lung adenocarcinoma, definitive diagnosis was established: primary pericardial mesothelioma

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).…”

“…The most common sites for this malignancy include the pleura (60-70%) and the peritoneum (30-35%). Primary pericardial mesothelioma accounts for only about 1% of all mesotheliomas (Karadzic et al, 2005;Papi et al, 2005).…”

“…Metastases are present in about 25-45% of the patients and involve regional lymph nodes, lung and kidney (Karadzic et al, 2005;Lagrotteria et al, 2005).…”

Primary Malignant Sarcomatoid Mesothelioma in the Pericardium

“…In an epidemiological survey, the incidence of PMPM was estimated to be 0.0022% (5). Making an antemortem diagnosis of PMPM is challenging and misdiagnosis is common (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). We encountered a case radiologically presenting with an anterior mediastinal mass and pericardial nodules, mimicking an anterior mediastinal tumor.…”

Pericardial Mesothelioma With Thrombovascular Complications (Case From Practice)

“…ПМТП локализуется в перикарде, но в результате злокачественного инвазивного ро-ста может инфильтрировать в эпикард и миокард желудочков и предсердий, коронарные синусы, коронарные артерии, проводящую систему серд-ца, распространяться на восходящую аорту или легочный ствол; метастазы в региональные лимфа-тические узлы и отдаленные метастазы выявляются у 25-40% больных [4,5]. Гистологически мезотели-омы гетерогенны, традиционно выделяют эпите-лиоидный, саркоматозный, десмопластический и бифазный варианты [6,7].…”