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Hirnle G, Kapałka M, Krawiec M, Hrapkowicz T. Pericardial mesothelioma mimicking mediastinal lymphoma and systemic rheumatic disease: a case report. Front Oncol 2025; 14:1481373. [PMID: 39896180 PMCID: PMC11782021 DOI: 10.3389/fonc.2024.1481373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 12/16/2024] [Indexed: 02/04/2025] Open
Abstract
Introduction Pericardial mesothelioma is an exceedingly rare pericardial neoplasm. It has atypical clinical symptoms and imaging characteristics that often lead to an inconclusive diagnosis. The diagnosis of a rare tumor such as pericardial mesothelioma, which can present with a variety of manifestations, requires a multidisciplinary approach. Case presentation A 36-year-old Caucasian female patient without significant past medical history was admitted to the hospital with chest pain and a high fever and was diagnosed with acute pericarditis. The following month, the patient was treated for sepsis; during this hospitalization, lab tests for antinuclear antibodies (ANA) turned out to be positive. Concurrently, mediastinal lymphadenopathy was observed. Given the suspicion of mediastinal lymphoma, a mediastinoscopy with lymph node biopsy was performed. Following a negative biopsy result, positron emission tomography combined with computed tomography (PET/CT) and blood immunophenotyping were performed. Both tests ruled out a diagnosis of lymphoma. Concurrently, the patient was hospitalized in the rheumatology department due to positive ANA results. There, in addition to the ANA titer at a level of 1:320, lupus anticoagulant was detected. The patient was diagnosed with systemic lupus erythematosus (SLE) and initiated on chronic steroid therapy. As heart failure progressed, the patient was admitted to the cardiology department. Tissue Doppler echocardiography and cardiac magnetic resonance imaging (MRI) revealed features indicative of constrictive pericarditis. The patient underwent a pericardiectomy with satisfactory results. However, the pathology result of the pericardium remained equivocal. The patient was readmitted 3 months later with severe circulatory failure, and a salvage procedure of pericardiectomy was performed. Histopathological examination of the sections confirmed the diagnosis of pericardial epithelioid mesothelioma. The patient died after 3 weeks of palliative care. Conclusions In the differential diagnosis of relapsing and resultant constrictive pericarditis, neoplastic processes that may mimic systemic rheumatic diseases should also be considered. Pericardial mesothelioma is a very rare diagnosis and may result in increased ANA titers, particularly anti-dense fine speckled 70 (DFS70) antibodies.
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Affiliation(s)
- Grzegorz Hirnle
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Michał Kapałka
- Student Scientific Association of Adult Cardiac Surgery, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Katowice, Poland
| | - Michał Krawiec
- Student Scientific Association of Adult Cardiac Surgery, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Katowice, Poland
| | - Tomasz Hrapkowicz
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
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Hai VA, Chau NTM, Hoanh HV, Van Tri H, Pho DC, Van Nam N. Long-term survival from multidisciplinary treatment of primary malignant pericardial mesothelioma: A case report. Int J Surg Case Rep 2024; 125:110615. [PMID: 39579634 PMCID: PMC11621602 DOI: 10.1016/j.ijscr.2024.110615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Revised: 11/11/2024] [Accepted: 11/13/2024] [Indexed: 11/25/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary malignant pericardial mesothelioma is an extremely rare disease with a poor prognosis. Currently, there are no specific guidelines for diagnosis and treatment in Vietnam and international countries for this disease, so treatment experiences from previous clinical cases are very important in the management of this disease. CASE PRESENTATION The research team reports a clinical case diagnosed and treated with a combination of surgery and chemotherapy using the Pemetrexed + Carboplatin regimen at the Oncology Center. The patient has survived for an additional 17 months up to the current time. CLINICAL DISCUSSION This is an exceptionally rare incident. He survived for a duration of 17 months, which is almost three times longer than the average survival time observed in other documented cases. Additional reports on cases with pericardial mesothelioma are necessary to have a comprehensive understanding of its nature, enabling early identification and appropriate treatment. CONCLUSION The patient underwent surgical intervention and received chemotherapy as part of their treatment. The research team emphasizes the importance of a multidisciplinary approach in diagnosing and treating primary malignant pericardial mesothelioma.
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Affiliation(s)
- Vu Anh Hai
- Oncology Center, Military Hospital 103, Vietnam Military Medical University, Hanoi 10000, Viet Nam
| | - Nghiem Thi Minh Chau
- Oncology Center, Military Hospital 103, Vietnam Military Medical University, Hanoi 10000, Viet Nam
| | - Ho Viet Hoanh
- Oncology Center, Military Hospital 103, Vietnam Military Medical University, Hanoi 10000, Viet Nam
| | - Ha Van Tri
- Oncology Center, Military Hospital 103, Vietnam Military Medical University, Hanoi 10000, Viet Nam
| | - Dinh Cong Pho
- Department of Cardiology, Heart Institute, 108 Military Central Hospital, Hanoi 100000, Viet Nam
| | - Nguyen Van Nam
- Department of Thoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi 10000, Viet Nam.
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Syed Ahmad SD, Kirk F, Wijesinghe W, He C, Stroebel A. A peculiar presentation of tamponade: pericardial mesothelioma. J Surg Case Rep 2024; 2024:rjae279. [PMID: 38711818 PMCID: PMC11070792 DOI: 10.1093/jscr/rjae279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/10/2024] [Indexed: 05/08/2024] Open
Abstract
Pericardial mesothelioma (PM) is rare with only 200 cases recorded, and a post-mortem prevalence of <0.0022%. It is the third most common cardiac/pericardial tumour, behind angiosarcoma and rhabdomyosarcoma. PM incidence increases with age, typically incidentally diagnosed between 50 and 70 years, with a 3:1 male predominance. Occasional PM can cause chest pain, dyspnoea, cough and even dysphagia. PMs are often misdiagnosed with only 25% of cases being antemortem diagnoses. Unlike pleural mesothelioma, the link between asbestos exposure and malignancy is less convincing, with only 20% of cases having known exposure. 6 There are three histological types: epithelioid, fibrous (spindle cell), and biphasic (mixed). The average life-expectancy post diagnosis is 3-10 months. Due to the heterogeneity of the presentation and rarity there is no standardized management algorithm, and the diagnostic imaging or laboratory investigations are scarcely described. We are presenting one of the cases diagnosed in our unit here in the Gold Coast.
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Affiliation(s)
- Syed Danial Syed Ahmad
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Level 4, D Block, Gold Coast University Hospital, 1 Hospital Boulevard, Gold Coast 4215, Australia
| | - Frazer Kirk
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Level 4, D Block, Gold Coast University Hospital, 1 Hospital Boulevard, Gold Coast 4215, Australia
| | - Wisalya Wijesinghe
- Bond University Faculty of Health Sciences & Medicine, 14 University Dr, Robina QLD 4226, Australia
| | - Cheng He
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Level 4, D Block, Gold Coast University Hospital, 1 Hospital Boulevard, Gold Coast 4215, Australia
| | - Andrie Stroebel
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Level 4, D Block, Gold Coast University Hospital, 1 Hospital Boulevard, Gold Coast 4215, Australia
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Fujiwara S, Kano Y, Maejima Y, Fujioka T, Tamura K, Kirimura S, Miyake S, Okamoto R. Clinical Response of Primary Malignant Pericardial Mesothelioma with Peritoneal Dissemination to Nivolumab. Intern Med 2024; 63:513-519. [PMID: 37380459 PMCID: PMC10937134 DOI: 10.2169/internalmedicine.1707-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/18/2023] [Indexed: 06/30/2023] Open
Abstract
Malignant pericardial mesothelioma (MPM) is extremely rare, and peritoneal dissemination has not yet been reported. There is no consensus regarding appropriate pharmacological treatment for MPM, including immune checkpoint inhibitors (ICIs). We herein report a 36-year-old man with MPM diagnosed by peritoneal dissemination and treated with an ICI. Cytology of the ascites revealed malignant peritonitis, and a re-evaluation of a pericardial biopsy performed at the previous hospital led to a diagnosis of MPM. The patient was treated with nivolumab and showed a clinical response despite several complications, such as renal dysfunction and performance status deterioration. This case report provides suggestive information for the diagnosis and ICI therapy of a rare type of mesothelioma.
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Affiliation(s)
- Shun Fujiwara
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University (TMDU), Japan
| | - Yoshihito Kano
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University (TMDU), Japan
- Department of Clinical Oncology, Tokyo Medical and Dental University (TMDU), Japan
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), Japan
| | - Tomoyuki Fujioka
- Department of Radiology, Tokyo Medical and Dental University (TMDU), Japan
| | - Kazuhiro Tamura
- Department of Pathology, Tokyo Medical and Dental University (TMDU), Japan
| | - Susumu Kirimura
- Department of Pathology, Tokyo Medical and Dental University (TMDU), Japan
| | - Satoshi Miyake
- Department of Clinical Oncology, Tokyo Medical and Dental University (TMDU), Japan
- Department of Palliative Care, Tsuchiura Kyodo General Hospital, Japan
| | - Ryuichi Okamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University (TMDU), Japan
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Wang D, Wang YH, Chu SC. Case Report: Early diagnosis and bevacizumab-based chemotherapy for primary pericardial mesothelioma: a case with occupational asbestos exposure history. Front Cardiovasc Med 2023; 10:1257373. [PMID: 38054089 PMCID: PMC10694204 DOI: 10.3389/fcvm.2023.1257373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
Background Primary pericardial mesothelioma (PPM) is an exceedingly rare malignant cancer and has a poor prognosis, which has been partly attributed to its frequently delayed diagnosis due to its nonspecific syndromes, its similar presentation to benign pericardial diseases, and its non-definitive etiology. In many PPM cases, the time from presentation to definite diagnosis may last for several months or even over one year. Unlike pleural mesothelioma, the relationship between PPM and asbestos exposure remains unsettled. To date, there is no consensus on the treatment of PPM. Case report The patient is a 57-year-old male who had nonspecific syndromes and inconclusive image findings. The occupational long-term asbestos exposure history of this patient raised our concerns regarding potential malignancy when confronted with unexplained pericardial effusion accompanied by cardiac tamponade. The heightened suspicion prompted us to perform pericardiocentesis and biopsy on the third day after admission to our department. An early diagnosis of PPM was established by the pathological and immunohistochemical evaluation of the biopsy specimen two weeks after admission. Positron emission tomography-computed tomography revealed that the lesion was localized at the anterior part of the mediastinum without distant metastasis. This patient refused to receive cardiac surgery. He subsequently underwent six cycles of chemotherapy (cisplatin plus pemetrexed) in combination with bevacizumab (a humanized anti-VEGF antibody) as the first-line treatment, resulting in complete relief of symptoms and satisfactory outcomes with no complications. Four months after the first course, the patient initiated a second course of chemotherapy with a similar regimen, but he opted to discontinue the medical treatment after the initiation of the second course. The patient was transferred to the hospice care unit and unfortunately expired one year after the initial presentation. Conclusion We present a case of an early multidisciplinary clinical approach to diagnose and manage PPM with consideration of occupational asbestos exposure history and clinical symptoms. Bevacizumab-based chemotherapy remains an option for the treatment of PPM.
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Affiliation(s)
- Daniel Wang
- The School of Medicine, Tzu Chi University, Hualien, Taiwan
- Faculty of Medicine, Umea University, Umea, Sweden
| | - Yung Hsuan Wang
- Division of Chest Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Sung Chao Chu
- Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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Dung BT, Hien NT, Dinh NH, Dat NQ, Khoi LM, Hoa T, Hieu TB, Duc NM. Multiple serous membrane effusion caused by primary pericardial mesothelioma. Radiol Case Rep 2023; 18:2903-2906. [PMID: 37388535 PMCID: PMC10300245 DOI: 10.1016/j.radcr.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023] Open
Abstract
Primary pericardial mesothelioma is an extremely rare cancer with a short survival prognosis. Clinical symptoms are often atypical, and most patients are diagnosed after surgery or at autopsy. We report a case of a 35-year-old female patient with multiple serous membrane effusion for more than 1 year. The patient underwent pericardial, pleural, and peritoneal fluid drainage many times and underwent many laboratory tests to find the cause; however, there was no definitive diagnosis. She was admitted to the hospital because of shortness of breath, cough, and sputum for 5 days. She underwent extensive pericardiectomy to resolve the dyspnea and pericardial surgery to find the cause of the multiple serous membrane effusion. After surgery, her dyspnea was relieved, and the serous effusion gradually decreased.
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Affiliation(s)
- Bui The Dung
- Department of Cardiology, University Medical Center HCMC, Ho Chi Minh City, Vietnam
| | - Nguyen Thanh Hien
- Department of Cardiology, University Medical Center HCMC, Ho Chi Minh City, Vietnam
| | - Nguyen Hoang Dinh
- Department of Heart Surgery, University Medical Center HCMC, Ho Chi Minh City, Vietnam
| | - Ngo Quoc Dat
- Department of Pathology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Le Minh Khoi
- Cardiovascular Imaging Unit, University Medical Center HCMC, Ho Chi Minh City, Vietnam
| | - Tran Hoa
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tran Ba Hieu
- Coronary Care Unit, Vietnam National Hearth Institute, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung Ward 12 Distric…, Ho Chi Minh City, 700000, Vietnam
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7
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Wu M, Li Z, Cai J, Zhong X, Zheng W, Wu S, Lin M, Zhang Q. Co-existing pericardial and pleural malignant mesothelioma responding well to nedaplatin and pemetrexed: a case report. AME Case Rep 2023; 7:32. [PMID: 37942039 PMCID: PMC10628414 DOI: 10.21037/acr-22-102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 07/05/2023] [Indexed: 11/10/2023]
Abstract
Background Malignant mesothelioma (MM) is a rare cancer with poor prognosis. It is less common that two serosal cavities are involved when the patient seeks medical attention firstly. The current first-line chemotherapy for advanced MM is a combination with cisplatin and pemetrexed. However, nedaplatin, a second-generation platinum-based antitumor agent, has the similar therapeutic effects as cisplatin but lower toxicity and higher water solubility. To our knowledge, this is the first case of co-existing pericardial and pleural MM treated with nedaplatin and pemetrexed and responding well. Case Description A 33-year-old woman, who had worked in a kiln for more than 10 years, suffered from dyspnea and chest tightness for 6 days. Chest computed tomography (CT) showed a massive pericardial effusion. She was diagnosed tuberculous pericarditis and received 6 months antituberculosis treatment (rifampicin, isoniazide, pyrazinamide, ethambutol). But it was ineffective and she was re hospitalized again due to massive pleural effusion and pericardial effusion. She was diagnosed with co-existing pericardial and pleural MM finally based on pleural biopsy and cytology of pericardial effusion. She was responding well excitedly to chemotherapy with nedaplatin and pemetrexed with high tolerance. Bone marrow toxicity or recurrent massive pericardial or pleural effusion were not observed during chemotherapy. However, she gave up chemotherapy and has survived for 22 months, from the onset symptoms. Conclusions In terms of clinical tolerance and less adverse reactions, we suggest that chemotherapy of nedaplatin with pemetrexed may be a more appropriate treatment in advanced MM. Further clinical trials are warrant.
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Affiliation(s)
- Mindan Wu
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
| | - Zhixuan Li
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Junfu Cai
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
| | - Xianyang Zhong
- Department of Gastroenterology, Shantou Central Hospital, Shantou, China
| | - Wenchuan Zheng
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
| | - Shuhan Wu
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
| | - Maohuang Lin
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
| | - Qichuan Zhang
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
- Shantou University Medical College, Shantou, China
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Abstract
Primary pericardial mesothelioma (PM) is a rare tumor arising from the mesothelial cells of the pericardium. It has an incidence of <0.05% and comprises <2% of all mesotheliomas; however, it is the most common primary malignancy of the pericardium. PM should be distinguished from secondary involvement by the spread of pleural mesothelioma or metastases, which are more common. Although data are controversial, the association between asbestos exposure and PM is less documented than that with other mesotheliomas. Late clinical presentation is common. Symptoms may be nonspecific but are usually related to pericardial constriction or cardiac tamponade, and diagnosis can be challenging usually requiring multiple imaging modalities. Echocardiography, computed tomography, and cardiac magnetic resonance demonstrate heterogeneously enhancing thickened pericardium, usually encasing the heart, with findings of constrictive physiology. Tissue sampling is essential for diagnosis. Histologically, similar to mesotheliomas elsewhere in the body, PM is classified as epithelioid, sarcomatoid, or biphasic, with the biphasic type being the most common. Combined with morphologic assessment, the use of immunohistochemistry and other ancillary studies is helpful for distinguishing mesotheliomas from benign proliferative processes and other neoplastic processes. The prognosis of PM is poor with about 22% 1-year survival. Unfortunately, the rarity of PM poses limitations for comprehensive and prospective studies to gain further insight into the pathobiology, diagnosis, and treatment of PM.
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9
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Strange CD, Marom EM, Ahuja J, Shroff GS, Gladish GW, Carter BW, Truong MT. Imaging of Malignant Pleural, Pericardial, and Peritoneal Mesothelioma. Adv Anat Pathol 2023; 30:280-291. [PMID: 36395181 DOI: 10.1097/pap.0000000000000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Malignant mesothelioma is a rare tumor arising from the mesothelial cells that line the pleura, pericardium, peritoneum, and tunica vaginalis. Imaging plays a primary role in the diagnosis, staging, and management of malignant mesothelioma. Multimodality imaging, including radiography, computed tomography (CT), magnetic resonance imaging (MRI), and F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT), is used in a variety of scenarios, including diagnosis, guidance for tissue sampling, staging, and reassessment of disease after therapy. CT is the primary imaging modality used in staging. MRI has superior contrast resolution compared with CT and can add value in terms of determining surgical resectability in equivocal cases. MRI can further assess the degree of local invasion, particularly into the mediastinum, chest wall, and diaphragm, for malignant pleural and pericardial mesotheliomas. FDG PET/CT plays a role in the diagnosis and staging of malignant pleural mesothelioma (MPM) and has been shown to be more accurate than CT, MRI, and PET alone in the staging of malignant pleural mesothelioma. PET/CT can also be used to target lesions for biopsy and to assess prognosis, treatment response, and tumor recurrence.
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Affiliation(s)
- Chad D Strange
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Edith M Marom
- Department of Diagnostic Radiology, Chaim Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | - Jitesh Ahuja
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Girish S Shroff
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gregory W Gladish
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brett W Carter
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mylene T Truong
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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Pernthaler B, Brcic L, Aigner RM, Fuchsjäger M, Talakic E. 18F-FDG PET/CT in Primary Mesothelioma of the Liver. Clin Nucl Med 2023; 48:49-51. [PMID: 36469059 DOI: 10.1097/rlu.0000000000004445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACT Primary malignant mesothelioma is a rarity among malignant liver tumors. We present the case of a 48-year-old woman presenting with increasing upper abdominal discomfort and inappetence accompanied by a weight loss of approximately 10 kg. CT and MRI revealed a highly suspicious mass lesion in the liver. 18F-FDG PET/CT performed for staging showed a pathological 18F-FDG uptake of the known liver tumor. Histology and immunohistochemistry indicated mesothelioma of the liver. Herein we present a rare case of primary mesothelioma in the liver with CT, MRI, and 18F-FDG PET/CT.
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Affiliation(s)
| | - Luka Brcic
- Diagnostic and Research Institute of Pathology
| | | | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Emina Talakic
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
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11
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Oka N, Orita Y, Oshita C, Nakayama H, Teragawa H. Primary malignant pericardial mesothelioma with difficult antemortem diagnosis: A case report. World J Clin Cases 2022; 10:12380-12387. [PMID: 36483836 PMCID: PMC9724547 DOI: 10.12998/wjcc.v10.i33.12380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/19/2022] [Accepted: 10/26/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Primary malignant pericardial mesothelioma (PMPM) is an extremely rare malignant tumor, and it is difficult to diagnose definitively before death. We present a case in which PMPM was diagnosed at autopsy. We consider this case to be highly suggestive and report it here. CASE SUMMARY A 78-year-old male presented with transient loss of consciousness and falls. The transient loss of consciousness was considered to result from complications of diastolic dysfunction due to pericardial disease, fever with dehydration, and paroxysmal atrial fibrillation. Ultrasound cardiography (UCG) and computed tomography showed cardiac enlargement and high-density pericardial effusion. We considered pericardial disease to be the main pathogenesis of this case. Cardiac magnetic resonance imaging and gadolinium contrast-enhanced T1-weighted images showed thick staining inside and outside the pericardium. Pericardial biopsy was considered to establish a definitive diagnosis, but the patient and his family refused further treatment and examinations, and the patient was followed conservatively. We noticed a thickening of the pericardium and massive changes in the pericardium on UCG over time. We performed an autopsy 60 h after the patient died of pneumonia. Giemsa staining of the autopsy tissue showed an epithelial-like arrangement in the pericardial tumor, and immunostaining showed positive and negative factors for the diagnosis of PMPM. Based on these findings, the final diagnosis of PMPM was made. CONCLUSION PMPM has a poor prognosis, and early diagnosis and treatment are important. The temporal echocardiographic findings may provide a clue for the diagnosis of PMPM.
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Affiliation(s)
- Naoya Oka
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima 734-8551, Japan
| | - Yuichi Orita
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
| | - Chikage Oshita
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
| | - Hirofumi Nakayama
- Department of Pathology, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
| | - Hiroki Teragawa
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
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Machii Y, Sezai A, Taoka M, Osaka S, Suzuki K, Onuki Y, Tanaka M. Coronary Artery Stenosis Caused by Primary Malignant Pericardial Mesothelioma in a 76-Year-Old Man. Tex Heart Inst J 2022; 49:488230. [PMID: 36350290 PMCID: PMC9809086 DOI: 10.14503/thij-20-7456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This report describes a 76-year-old man with diabetes mellitus who developed coronary artery stenosis from infiltration of a primary malignant pericardial mesothelioma. Three months before referral to the treating hospital, elevated liver function values and cardiac enzymes led to echocardiography, which revealed a motion abnormality in the anterior wall of the heart. The patient was diagnosed with congestive heart failure and admitted to the hospital, where chest computed tomography showed a tumor above the left atrial appendage that compressed the origin of the left anterior descending artery. He was referred to the treating hospital for surgery. Minimally invasive direct coronary artery bypass grafting was performed, but the mass was not resected because of its infiltrating nature and the potential for medical complications. Histologic examination of a biopsy specimen confirmed a primary malignant pericardial mesothelioma. The bypass procedure resolved the coronary artery stenosis caused by the tumor. Although the optimal treatment for primary malignant pericardial mesothelioma is controversial, minimally invasive methods, such as minimally invasive direct coronary artery bypass grafting, may be used successfully.
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Affiliation(s)
- Yojiro Machii
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Akira Sezai
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Taoka
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Shunji Osaka
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Keito Suzuki
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiki Onuki
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masashi Tanaka
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
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Fukasawa N, Agemi Y, Shiba A, Aga M, Hamakawa Y, Miyazaki K, Taniguchi Y, Misumi Y, Shimokawa T, Ono K, Hayashi H, Okamoto H. A case of slowly progressive malignant pericardial mesothelioma suggesting the involvement of BAP1 loss. Respirol Case Rep 2022; 10:e01004. [PMID: 35950141 PMCID: PMC9356387 DOI: 10.1002/rcr2.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/20/2022] [Indexed: 11/08/2022] Open
Abstract
Malignant pericardial mesothelioma (MPM) is a rare tumour that arises from the mesothelial cells of the pericardium. No standard treatment has been established owing to a poor treatment response; therefore, MPM has a poor prognosis. We herein report a rare case of MPM in a 70-year-old man that was diagnosed immunohistopathologically using cell block sections of pericardial fluid and in which long-term survival for more than 3 years was achieved with only periodic pericardial drainage. Immunohistopathological staining investigations, especially BRCA1-associated protein 1 (BAP1) immunostaining using cell block sections of pericardial effusion, are effective in making a diagnosis of MPM. Well-differentiated papillary mesothelioma (WDPM) with BAP1 loss progresses to MPM in the long term, showing that BAP1 loss may induce phenotypical evolution of WDPM. BAP1 loss may also progress to malignant mesothelioma in situ and then to invasive mesothelioma. BAP1 immunohistochemistry should be considered for the early diagnosis of MPM.
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Affiliation(s)
- Naoto Fukasawa
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Yoko Agemi
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Aya Shiba
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Masaharu Aga
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Yusuke Hamakawa
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Kazuhito Miyazaki
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Yuri Taniguchi
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Yuki Misumi
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Tsuneo Shimokawa
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Kyoko Ono
- Department of PathologyKanagawa Cancer CenterYokohamaJapan
| | - Hiroyuki Hayashi
- Department of PathologyYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Hiroaki Okamoto
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
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14
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Seal S, Simon H. Primary Pericardial Mesothelioma: A Rare but Serious Consideration. Cureus 2021; 13:e19966. [PMID: 34984126 PMCID: PMC8714056 DOI: 10.7759/cureus.19966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2021] [Indexed: 11/22/2022] Open
Abstract
Primary pericardial mesothelioma (PPM) is an extremely rare malignancy with a very poor prognosis. It poses a diagnostic challenge given its often late and non-specific presentation. This report describes a 74-year-old man who presented with central pleuritic chest pain and mild breathlessness. The patient was febrile and mildly tachycardic with crepitations in the right lung base. Blood tests revealed raised inflammatory markers and chest X-ray showed no acute pathology. Following admission, CT pulmonary angiogram showed a large left-sided mediastinal mass (approximately 110 x 70 x 85 mm) centered on the pericardium. Further post venous phase CT imaging identified possible myocardial invasion alongside suspicious liver nodules. Later, outpatient fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging highlighted further FDG avid pleural and liver lesions. CT-guided biopsy of the pericardial lesion was undertaken, with histology and immunohistochemistry indicating epitheliod-type mesothelioma. A significant malignant pericardial effusion was also identified, which ultimately required pericardial window formation. Immunotherapy was commenced utilizing dual nivolumab and ipilimumab, a novel regime for the treatment of mesothelioma. Palliative radiotherapy to the pericardial lesion will also be performed. Here, we demonstrate the diagnostic challenge of this vanishingly rare condition, which is usually diagnosed upon the development of associated complications. Early recognition gives the best chance of improved mortality, however, diagnosis requires a high index of clinical suspicion alongside prompt investigation, primarily involving cross-sectional imaging.
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15
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Brydges H, Yin K, Balasubramaniyan R, Lawrence KW, Luo R, Karlson KJ, McAneny DB, Edwards NM, Reardon MJ, Dobrilovic N. Primary Pericardial Mesothelioma: A Population-Based Propensity Score-Matched Analysis. Semin Thorac Cardiovasc Surg 2021; 34:1113-1119. [PMID: 34320396 DOI: 10.1053/j.semtcvs.2021.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/11/2022]
Abstract
Primary pericardial mesothelioma is a rare malignancy of the mesothelial lining of the pericardium. This study aimed to evaluate the clinical characteristics and survival outcomes of these patients using a United States population-based cancer database. We queried the Surveillance, Epidemiology, and End Results program (1973-2015). Primary pericardial mesothelioma patients with complete follow-up data were included, and primary pleural mesothelioma patients were identified as controls. Propensity-score matching was used to balance individual characteristics. Kaplan-Meier analysis and log-rank tests were performed to compare overall survival. Forty-one primary pericardial mesothelioma and 15,970 primary pleural mesothelioma patients were identified. Before matching, when compared to the pleural mesothelioma counterparts, primary pericardial mesothelioma patients were younger (median 57 vs 73 years, P < 0.001), more likely to be female (46.3% vs 20.2%, P < 0.001), more likely to be nonwhite (24.4% vs 8.4%, P = 0.001), and less likely to have been diagnosed in the most recent study decade (2006-2015, 34.1% vs 43.5%, P = 0.002). The overall 1- and 2-year survival rates were 22.0% and 12.2%, with a median survival of 2 months (IQR: 1-6). After 1:2 nearest neighbor propensity-score matching, 38 pericardial mesothelioma and 76 matched pleural mesothelioma cases were identified. The 2 matched groups had comparable baseline characteristics, including age, sex, race, year of diagnosis, histological type, and cancer history. Compared to their pleural mesothelioma counterparts, primary pericardial mesothelioma patients were less likely to receive chemotherapy (23.7% vs 50.0%, P = 0.01) and had worse overall survival (median survival: 2 vs 10 months, log-rank P = 0.006). Primary pericardial mesothelioma has worse survival outcomes than pleural mesothelioma, with a median survival of only 2 months. These patients should seek care from experienced multidisciplinary teams at tertiary care centers that handle high volumes of mesothelioma patients.
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Affiliation(s)
- Hilliard Brydges
- Division of Cardiac Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Kanhua Yin
- Division of Cardiac Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Ramkumar Balasubramaniyan
- Division of Cardiac Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Kyle W Lawrence
- Division of Cardiac Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Karl J Karlson
- Division of Cardiac Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - David B McAneny
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Niloo M Edwards
- Division of Cardiac Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas
| | - Nikola Dobrilovic
- Division of Cardiac Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
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16
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Abstract
Purpose of Review Cardiac masses frequently present significant diagnostic and therapeutic clinical challenges and encompass a broad set of lesions that can be either neoplastic or non-neoplastic. We sought to provide an overview of cardiac tumors using a cardiac chamber prevalence approach and providing epidemiology, imaging, histopathology, diagnostic workup, treatment, and prognoses of cardiac tumors. Recent Findings Cardiac tumors are rare but remain an important component of cardio-oncology practice. Over the past decade, the advances in imaging techniques have enabled a noninvasive diagnosis in many cases. Indeed, imaging modalities such as cardiac magnetic resonance, computed tomography, and positron emission tomography are important tools for diagnosing and characterizing the lesions. Although an epidemiological and multimodality imaging approach is useful, the definite diagnosis requires histologic examination in challenging scenarios, and histopathological characterization remains the diagnostic gold standard. Summary A comprehensive clinical and multimodality imaging evaluation of cardiac tumors is fundamental to obtain a proper differential diagnosis, but histopathology is necessary to reach the final diagnosis and subsequent clinical management.
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17
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Farhat SB, Salah M, Milouchi S. Primary malignant pericardial mesothelioma: a case report. Pan Afr Med J 2020; 36:375. [PMID: 33235652 PMCID: PMC7666705 DOI: 10.11604/pamj.2020.36.375.25336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 11/17/2022] Open
Abstract
Metastases to the heart and pericardium are much more common than primary malignant neoplasms. Primary malignant pericardial mesothelioma is a rare tumor that arises from the mesothelial cells of the pericardium. It is usually characterized by a delayed diagnosis, a low response to treatment, and a poor prognosis with an overall survival up to six months after the onset of symptoms. We report a rare case of a 32-year-old woman with primary pericardial malignant mesothelioma that was diagnosed 4 months after the onset of pericardial effusion as the first clinical manifestation.
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Affiliation(s)
- Sameh Ben Farhat
- Cardiology Department, Habib Bourguiba University Hospital, Medenine, Tunisia
| | - Maroua Salah
- Cardiology Department, Habib Bourguiba University Hospital, Medenine, Tunisia
| | - Sami Milouchi
- Cardiology Department, Habib Bourguiba University Hospital, Medenine, Tunisia
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18
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Matsuyama S, Imazuru T, Uchiyama M, Ota H, Iida M, Shimokawa T. Primary malignant pericardial mesothelioma presenting with cardiac tamponade. Int J Surg Case Rep 2020; 73:253-256. [PMID: 32717680 PMCID: PMC7385038 DOI: 10.1016/j.ijscr.2020.07.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Primary malignant pericardial mesothelioma is a rare tumor that is very difficult to diagnose. Furthermore, it is a lethal disease, because patients usually have progressed at the time of referral. PRESENTATION OF THE CASE We report a 44-year-old man with primary malignant pericardial mesothelioma. He was referred to our hospital for the diagnosis and treatment of a massive pericardial effusion and huge tumor. Pericardiocentesis was performed, but we could not obtain definitive diagnosis, and the cardiac tamponade continued along with the signs/symptoms. He required surgical intervention for the diagnosis and treatment. After surgery, his signs/symptoms improved. He received adjuvant therapy, although he died 7 months after surgery. DISCUSSION Primary malignant pericardial mesothelioma is a rare tumor. The most common signs and symptoms are related to constriction of the heart by the tumor and/or effusion. Even if the pericardial fluid specimen obtained by pericardiocentesis is negative for malignant cells, primary malignant pericardial mesothelioma should be included in the differential diagnosis. Because the malignancy is usually advanced at the time of diagnosis, it has been difficult to cure. Radiation and chemotherapy have been used in addition to surgery, but have been minimally effective. CONCLUSION The outcome of our patient with pericardial malignant mesothelioma was dismal. The indications for surgical intervention should be carefully considered except for critical cases requiring alleviation of immediate life-threating conditions.
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Affiliation(s)
- Shigefumi Matsuyama
- Department of Cardiovascular Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan; Department of Cardiovascular Surgery, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan.
| | - Tomohiro Imazuru
- Department of Cardiovascular Surgery, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
| | - Masateru Uchiyama
- Department of Cardiovascular Surgery, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
| | - Hiroo Ota
- Department of Cardiovascular Surgery, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
| | - Mitsuru Iida
- Department of Cardiovascular Surgery, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
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19
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Rosenbaum AN, Bois MC, Zhang X, Santivasi WL, Freeman WK. Primary Malignant Pericardial Mesothelioma: A Clinical Case Series Illustrating the Necessity of a Multidisciplinary Approach. JACC Case Rep 2019; 1:202-207. [PMID: 34316785 PMCID: PMC8301520 DOI: 10.1016/j.jaccas.2019.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/11/2019] [Accepted: 06/19/2019] [Indexed: 11/23/2022]
Abstract
Primary malignant pericardial mesothelioma is a rare cardiac neoplasm. The authors evaluated risk factors, clinical presentation, and outcomes by reviewing all biopsy-confirmed cases at one institution. The use of multimodality imaging, detailed hemodynamic assessment for the presence of an effusive-constrictive profile, and cytology evaluation can support the diagnosis. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Andrew N Rosenbaum
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - Melanie C Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota
| | - Xin Zhang
- Department of Internal Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - Wil L Santivasi
- Department of Internal Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - William K Freeman
- Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona
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20
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Song G, Bi W, Zhang X, Huang W, Zhou K, Ren W. Localized primary malignant pericardial mesothelioma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:178-181. [PMID: 30450660 DOI: 10.1002/jcu.22673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 09/29/2018] [Accepted: 10/28/2018] [Indexed: 06/09/2023]
Abstract
Primary malignant pericardial mesothelioma (PMPM) is an extremely rare tumor, which may appear as a localized or a diffuse mass encasing the heart. Diffuse PMPMs have a poor prognosis due to the difficulty of surgical excision, whereas localized PMPMs have clear margins, thus facilitating surgical excision. Timely diagnosis and proper treatment are crucial for a favorable prognosis. Eight cases of localized PMPMs have been reported so far, but their characteristics have not been fully described. Herein, we present a patient with localized PMPM and describe the diagnosis methods, treatment, and outcomes of these tumors.
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Affiliation(s)
- Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wenjing Bi
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xintong Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wanying Huang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ke Zhou
- Department of Cardiac Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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21
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Treatment and Outcomes of Primary Pericardial Mesothelioma: A Contemporary Review of 103 Published Cases. Clin Lung Cancer 2019; 20:e152-e157. [DOI: 10.1016/j.cllc.2018.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/11/2018] [Accepted: 11/23/2018] [Indexed: 12/16/2022]
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22
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Hui M, Harshavardhana KR, Uppin SG. Pericardial mesothelioma presenting as chronic constrictive pericarditis. A series of three cases from a single institution. INDIAN J PATHOL MICR 2019; 61:573-576. [PMID: 30303153 DOI: 10.4103/ijpm.ijpm_711_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pericardial mesotheliomas are rare tumors which often present with features of constrictive pericarditis. We present clinical, imaging, histological, and immunohistochemical findings of three cases presenting with chronic constrictive pericarditis. Two of these cases were initially treated as tuberculous pericarditis. Histologically, all the three cases were of an epithelioid type and showed positivity for more than one mesothelial markers. Two patients had a fatal outcome, and one was lost to follow-up.
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Affiliation(s)
- Monalisa Hui
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - K R Harshavardhana
- Department of Radiology and Imageology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Shantveer G Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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23
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Shikano K, Hirano S, Hiroishi T, Hayama N, Fujita T, Amano H, Nakamura M, Nakamura S, Tabeta H, Ichinose S, Uchida O, Shimizu S. The Antemortem Diagnosis of Primary Malignant Pericardial Mesothelioma: A Multidisciplinary Evaluation. Intern Med 2018; 57:2559-2562. [PMID: 29709931 PMCID: PMC6172541 DOI: 10.2169/internalmedicine.0355-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A 64-year-old woman complaining of progressive dyspnea was admitted with recurrence of massive pericardial effusion. The patient had been diagnosed with radiation pericarditis based on a previous case of pericardiocentesis. To make a diagnosis and improve her symptoms, imaging examinations and pericardial fenestration were performed. Because of difficulty making a diagnosis, after some months, pericardiotomy and incision of the epicardium were performed. The patient was ultimately diagnosed with primary malignant pericardial mesothelioma of the epithelioid type. Primary malignant pericardial mesothelioma is a rare tumor that is difficult to diagnose. An antemortem diagnosis can be made by a multidisciplinary evaluation.
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Affiliation(s)
- Kohei Shikano
- Department of Respiratory Medicine, Funabashi Municipal Medical Center, Japan
| | - Satoshi Hirano
- Department of Medical Oncology, Funabashi Municipal Medical Center, Japan
| | - Takuma Hiroishi
- Department of Respiratory Medicine, Funabashi Municipal Medical Center, Japan
| | - Noriko Hayama
- Department of Respiratory Medicine, Funabashi Municipal Medical Center, Japan
| | - Tetsuo Fujita
- Department of Respiratory Medicine, Funabashi Municipal Medical Center, Japan
| | - Hiroyuki Amano
- Department of Respiratory Medicine, Funabashi Municipal Medical Center, Japan
| | - Makoto Nakamura
- Department of Respiratory Medicine, Funabashi Municipal Medical Center, Japan
| | - Sukeyuki Nakamura
- Department of Respiratory Medicine, Funabashi Municipal Medical Center, Japan
| | - Hiroshi Tabeta
- Department of Respiratory Medicine, Funabashi Municipal Medical Center, Japan
| | - Shuji Ichinose
- Department of Thoracic Surgery, Funabashi Municipal Medical Center, Japan
| | - Osamu Uchida
- Department of Thoracic Surgery, Funabashi Municipal Medical Center, Japan
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24
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Kong L, Li Z, Wang J, Lv X. Echocardiographic characteristics of primary malignant pericardial mesothelioma and outcomes analysis: a retrospective study. Cardiovasc Ultrasound 2018; 16:7. [PMID: 29695235 PMCID: PMC5922299 DOI: 10.1186/s12947-018-0125-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 04/04/2018] [Indexed: 12/18/2022] Open
Abstract
Background Little is known about the echocardiographic characteristics of primary malignant pericardial mesothelioma (PPM) due to its rarity. The aim of this study was to explore the sex-specific echocardiographic patterns of PPM and risk factors for in-hospital mortality. Methods A retrospective information retrieval was conducted for cases of PPM reported from China during 1981 and 2015. The diagnosis was made by histopathological examinations and only cases with echocardiographic descriptions were included. Data on the clinical and echocardiographic findings were collected. Difference in clinical, sex-specific echocardiographic characteristics and findings across different time periods were assessed. Logistic regression analysis was performed to explore echocardiographic risk factors for in-hospital mortality. Results A total of 64 patients with PPM were included, with a mean age of 39.2 ± 15.6 years and minor male dominance (40, 62.5%). The most common echocardiographic presentations were pericardial effusion (55, 85.9%), pericardial masses (36.4%) and thickening (17.3%), respectively. The positive rate of pericardiocentesis was only 20.9%. Six patients (15.4%) died among 39 cases reporting in-hospital outcome. Logistics analysis identified no clinical or echocardiographic parameters associated with in-hospital mortality (all P > 0.05). Conclusions The echocardiographic signs of PPM are basically nonspecific with massive pericardial effusion as the most common sign, although no echocardiographic gender differences or association with in-hospital mortality could be identified.
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Affiliation(s)
- Lingyun Kong
- Echocardiography Department of Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Ziwang Li
- Department of Cardiology, Jiang Xi Yichun Hospital of Traditional Chinese Medicine, Jiang Xi, China
| | - Jingrui Wang
- Department of Cardiology, Beijing Daxing District people's Hospital, Beijing, China
| | - Xiuzhang Lv
- Echocardiography Department of Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
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25
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Kim JS, Lim SY, Hwang J, Kang EJ, Choi YJ. A Case Report of Primary Pericardial Malignant Mesothelioma Treated with Pemetrexed and Cisplatin. J Korean Med Sci 2017; 32:1879-1884. [PMID: 28960045 PMCID: PMC5639073 DOI: 10.3346/jkms.2017.32.11.1879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/08/2016] [Indexed: 01/02/2023] Open
Abstract
Primary pericardial malignant mesothelioma (PPM) is a very rare malignancy, with an incidence of less than 0.002% and represents less than 5% of all mesotheliomas. The cause of pericardial mesothelioma is uncertain that differ from pleural mesothelioma which is associated with asbestos exposure. This malignancy is terribly aggressive and has very poor prognosis with less than six months of overall survival. We present a case of a 71-year-old woman who was diagnosed with cardiac tamponade caused by PPM and received chemotherapy with pemetrexed and cisplatin for six months. During two years she was alive without disease progression. To better understand the clinical, pathologic features and treatment outcome of this entity, we reviewed 23 cases described in the English literature from 2009, together with our case, provided a total of 24 cases. Based on this review, we suggest that PPM must be considered in patients who have unexplained massive pericardial effusion and recommend chemotherapy with pemetrexed and cisplatin for the better outcome of PPM.
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Affiliation(s)
- Jung Sun Kim
- Division of Hematology/Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sang Yup Lim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jinwook Hwang
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, Korea
| | - Eun Joo Kang
- Division of Hematology/Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yoon Ji Choi
- Division of Hematology/Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
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26
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Muta H, Sugita Y, Ohshima K, Otsubo H. Primary malignant pericardial sarcomatoid mesothelioma: An autopsy report. Pathol Int 2017; 67:311-315. [PMID: 28463437 DOI: 10.1111/pin.12535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 04/06/2017] [Indexed: 11/30/2022]
Abstract
Primary malignant pericardial sarcomatoid mesothelioma (PMPSM) is an extremely rare tumor with poor prognosis. We present an autopsy case in an 80-year-old man admitted for heart failure after one month of treatment at an outpatient clinic. He died three months after symptom onset. A complete autopsy revealed localization of the tumor to the pericardium without other lesions. Histologically, mainly spindle-shaped atypical cells with hyperchromatic nuclei and nucleoli were observed. Immunohistochemical markers for mesothelioma were positive for calretinin, cytokeratin AE1/AE3, and cytokeratin CAM5.2. Thus, we diagnosed primary sarcomatoid malignant mesothelioma of the pericardium. To our knowledge, only four PMPSM cases have been reported in the English literature in the past 30 years. Although PMPSM is rare, clinicians and pathologists should recognize it as a possible diagnosis of pericardial tumors. It is necessary to accumulate clinical and pathological diagnostic findings to establish early detection methods for this extremely rare disease.
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Affiliation(s)
- Hiroko Muta
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Yasuo Sugita
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
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27
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Mezei G, Chang ET, Mowat FS, Moolgavkar SH. Epidemiology of mesothelioma of the pericardium and tunica vaginalis testis. Ann Epidemiol 2017; 27:348-359.e11. [PMID: 28527639 DOI: 10.1016/j.annepidem.2017.04.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 01/10/2017] [Accepted: 04/06/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Malignant mesothelioma most commonly arises in the pleura and peritoneum but also occurs rarely at other anatomical sites with mesothelial tissue, namely, the pericardium and tunica vaginalis testis (TVT). This review provides a better understanding of the epidemiology of mesothelioma of these extrapleural sites. METHODS We conducted a systematic review of the epidemiologic and clinical literature on pericardial mesothelioma and mesothelioma of the TVT. We also analyzed U.S. Surveillance, Epidemiology, and End Results cancer registry data to describe incidence patterns of these malignancies. RESULTS An etiologic role of asbestos exposure has been hypothesized for pericardial and TVT mesotheliomas, but no analytical case-control epidemiologic studies exist to test this relationship. A substantial proportion of cases with these malignancies report no known asbestos exposure. In large occupational cohorts with heavy asbestos exposures, no cases of pericardial or TVT mesothelioma have been reported. Trends in the incidence of these malignancies do not match those of pleural mesothelioma, which correspond to historical trends of commercial asbestos use. A male preponderance of pericardial mesothelioma is not evident. CONCLUSIONS In the absence of analytic epidemiologic studies, the etiologic role of environmental risk factors for mesothelioma of the pericardium and TVT remains elusive.
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Affiliation(s)
- Gabor Mezei
- Health Sciences Center, Exponent, Inc., Menlo Park, CA.
| | - Ellen T Chang
- Health Sciences Center, Exponent, Inc., Menlo Park, CA
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Pericardial mesothelioma presenting as a suspected ST-elevation myocardial infarction. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Barroso AS, Leite S, Friões F, Vasconcelos M, Azevedo D, Baldaia H, Amorim MJ, Dias P. Pericardial mesothelioma presenting as a suspected ST-elevation myocardial infarction. Rev Port Cardiol 2017; 36:307.e1-307.e5. [PMID: 28343785 DOI: 10.1016/j.repc.2016.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/27/2016] [Accepted: 03/07/2016] [Indexed: 10/19/2022] Open
Abstract
Primary cardiac and pericardial tumors are rare entities with an autopsy frequency of 0.001-0.03%. Metastases to the heart and pericardium are much more common than primary tumors. Malignant pericardial mesotheliomas account for up to 50% of primary pericardial tumors. We report the case of a 75-year-old woman with hypertension, dyslipidemia and atrial fibrillation who went to the emergency department due to nonspecific thoracic discomfort of over six hours duration associated with syncope. Physical examination revealed a low-amplitude arrhythmic pulse, no heart murmurs and no signs of pulmonary congestion. The ECG revealed atrial fibrillation with ST-segment elevation in V2-V6, I and aVL. The patient was transferred for emergent coronary angiography, which revealed a long stenosis in the mid-distal portion of the left anterior descending artery. The echocardiogram showed a large pericardial effusion with diffuse thickening of the myocardium. Due to worsening hemodynamics, cardiac rupture was suspected and the patient underwent urgent sternotomy and pericardiotomy with drainage of a large quantity of hematic fluid. The surgeons then identified a large, unresectable tumor occupying the distal half of the anterior portion of the heart. This is, to our knowledge, the first case report of primary pericardial mesothelioma presenting with suspected ST-elevation myocardial infarction. In this case, direct observation of the tumor led to biopsy and the final diagnosis. These are highly malignant tumors and when diagnosed are usually already at an advanced stage.
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Affiliation(s)
- Ana Sofia Barroso
- Unidade de Cuidados Intermédios de Medicina, Centro Hospitalar São João, Porto, Portugal.
| | - Sérgio Leite
- Serviço de Cardiologia, Centro Hospitalar São João, Porto, Portugal
| | - Fernando Friões
- Unidade de Cuidados Intermédios de Medicina, Centro Hospitalar São João, Porto, Portugal
| | | | - Daniela Azevedo
- Serviço de Oncologia, Centro Hospitalar São João, Porto, Portugal
| | - Helena Baldaia
- Serviço de Anatomia Patológica, Centro Hospitalar São João, Porto, Portugal
| | - Mário Jorge Amorim
- Serviço de Cirurgia Cardiotorácica, Centro Hospitalar São João, Porto, Portugal
| | - Paula Dias
- Unidade de Cuidados Intermédios de Medicina, Centro Hospitalar São João, Porto, Portugal
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Betancor J, Xu B, Kumar A, Tan CD, Rodriguez ER, Flamm SD, Asher CR, Klein AL. A Malignant Case of Constrictive Pericarditis. ACTA ACUST UNITED AC 2017; 1:17-22. [PMID: 30062235 PMCID: PMC6034467 DOI: 10.1016/j.case.2016.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jorge Betancor
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bo Xu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Arnav Kumar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Carmela D Tan
- Department of Anatomic Pathology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - E Rene Rodriguez
- Department of Anatomic Pathology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott D Flamm
- Department of Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Craig R Asher
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Allan L Klein
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Cao S, Jin S, Cao J, Shen J, Zhang H, Meng Q, Pan B, Yu Y. Malignant pericardial mesothelioma : A systematic review of current practice. Herz 2017; 43:61-68. [PMID: 28130567 DOI: 10.1007/s00059-016-4522-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 10/11/2016] [Accepted: 11/26/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Malignant mesothelioma is a rare but aggressive tumor, with a high misdiagnosis rate and overall bleak prognosis. In 0.7% of all cases, the origin is the pericardium. METHODS The present study is a review of the literature published in recent decades focusing on the advances in clinical manifestations, radiological findings, diagnosis, differential diagnosis, and treatment of malignant pericardial mesothelioma (MPM). RESULTS No clear relationship has been established between the etiologies and the development of MPM. Clinical symptoms and signs are nonspecific when present. The main presentations are chest pain and dyspnea. Imaging plays an important role in the detection, characterization, staging, and posttreatment follow-up. The definitive diagnosis is made on the basis of pathological findings. Chest radiography and echocardiography are common techniques used initially, but their roles are limited. Computed tomography and magnetic resonance imaging have an advantage in depicting the thickened pericardium, mediastinal lymph node, tumor, and the extension of adjacent structures. Surgery is the most important treatment modality and remains palliative in most cases, while the roles of chemo- and radiotherapy are unsatisfactory. CONCLUSION Clinical trials of malignant pleural and peritoneal mesothelioma remain important for MPM management. Multimodality treatment of surgery, chemotherapy, radiotherapy, and immunotherapy is expected to have a role in the treatment of MPM.
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Affiliation(s)
- S Cao
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, No. 150 Haping Road, 150081, Harbin, China
| | - S Jin
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, No. 150 Haping Road, 150081, Harbin, China
| | - J Cao
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, No. 150 Haping Road, 150081, Harbin, China
| | - J Shen
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, No. 150 Haping Road, 150081, Harbin, China
| | - H Zhang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, No. 150 Haping Road, 150081, Harbin, China
| | - Q Meng
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, No. 150 Haping Road, 150081, Harbin, China
| | - B Pan
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, No. 150 Haping Road, 150081, Harbin, China
| | - Y Yu
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, No. 150 Haping Road, 150081, Harbin, China.
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Bokma JP, Rijlaarsdam MA, Ambarus CA, Bindraban NR. A rare cause of pericardial constriction. Int J Cardiol 2016; 223:497-499. [PMID: 27552563 DOI: 10.1016/j.ijcard.2016.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/03/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jouke P Bokma
- Department of Cardiology, Academic Medical Center Amsterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - Martin A Rijlaarsdam
- Department of Cardiology, Academic Medical Center Amsterdam, The Netherlands; Department of Internal Medicine, Academic Medical Center Amsterdam, The Netherlands
| | - Carmen A Ambarus
- Department of Pathology, Academic Medical Center Amsterdam, The Netherlands
| | - Navin R Bindraban
- Department of Cardiology, Academic Medical Center Amsterdam, The Netherlands.
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Kurosawa T, Sugino K, Isobe K, Hata Y, Fukasawa Y, Homma S. Primary malignant pericardial mesothelioma with increased serum mesothelin diagnosed by surgical pericardial resection: A case report. Mol Clin Oncol 2016; 5:553-556. [PMID: 27900083 DOI: 10.3892/mco.2016.1019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/25/2016] [Indexed: 12/29/2022] Open
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.
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Affiliation(s)
- Takeyuki Kurosawa
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo 143-8541, Japan
| | - Keishi Sugino
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo 143-8541, Japan
| | - Kazutoshi Isobe
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo 143-8541, Japan
| | - Yoshinobu Hata
- Department of Chest Surgery, Toho University Omori Medical Center, Tokyo 143-8541, Japan
| | - Yuri Fukasawa
- Department of Pathology, Toho University Omori Medical Center, Tokyo 143-8541, Japan
| | - Sakae Homma
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo 143-8541, Japan
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Fatima U, Gupta S, Firchau DJ, Stolpen AH, Sah R. A Rare Pericardial Malignancy. Circ Heart Fail 2016; 9:CIRCHEARTFAILURE.116.003282. [PMID: 27413030 DOI: 10.1161/circheartfailure.116.003282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Urooj Fatima
- From the Department of Internal Medicine (U.F.), Department of Pathology (S.G., D.J.F.), Department of Radiology (A.H.S.), and Department of Internal Medicine, Division of Cardiovascular Medicine (R.S.), University of Iowa, Carver College of Medicine, Iowa City
| | - Sarika Gupta
- From the Department of Internal Medicine (U.F.), Department of Pathology (S.G., D.J.F.), Department of Radiology (A.H.S.), and Department of Internal Medicine, Division of Cardiovascular Medicine (R.S.), University of Iowa, Carver College of Medicine, Iowa City
| | - Dennis J Firchau
- From the Department of Internal Medicine (U.F.), Department of Pathology (S.G., D.J.F.), Department of Radiology (A.H.S.), and Department of Internal Medicine, Division of Cardiovascular Medicine (R.S.), University of Iowa, Carver College of Medicine, Iowa City
| | - Alan H Stolpen
- From the Department of Internal Medicine (U.F.), Department of Pathology (S.G., D.J.F.), Department of Radiology (A.H.S.), and Department of Internal Medicine, Division of Cardiovascular Medicine (R.S.), University of Iowa, Carver College of Medicine, Iowa City
| | - Rajan Sah
- From the Department of Internal Medicine (U.F.), Department of Pathology (S.G., D.J.F.), Department of Radiology (A.H.S.), and Department of Internal Medicine, Division of Cardiovascular Medicine (R.S.), University of Iowa, Carver College of Medicine, Iowa City.
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Chung SM, Choi SJ, Kim MJ, Choi JY, Kim HJ, Lee SY, Kang EJ. Positive response of a primary malignant pericardial mesothelioma to pemetrexed plus cisplatin followed by pemetrexed maintenance chemotherapy: A case report. Oncol Lett 2016; 12:213-216. [PMID: 27347127 DOI: 10.3892/ol.2016.4598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/05/2016] [Indexed: 12/18/2022] Open
Abstract
Primary malignant pericardial mesothelioma (PMPM) is a rare tumor with poor prognosis. Surgery is the treatment of choice, but numerous cases are inoperable. For the treatment of inoperable or metastatic cases, systemic chemotherapy is required. However, a standard chemotherapeutic regimen for the treatment of pericardial mesothelioma has not yet been established. Chemotherapy involving pemetrexed and cisplatin has been actively used in the treatment of pleural or peritoneal mesothelioma, and may be considered for the treatment of PMPM. The present study reports the case of a patient with PMPM with lung metastasis who demonstrated a positive response to treatment with pemetrexed and cisplatin followed by pemetrexed maintenance chemotherapy, leading to prolonged progression-free survival for 21 months.
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Affiliation(s)
- Sang Mi Chung
- Division of Medical Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center, Guro Hospital, Seoul 08308, Republic of Korea
| | - Seong Ji Choi
- Division of Medical Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center, Guro Hospital, Seoul 08308, Republic of Korea
| | - Min Jung Kim
- Division of Medical Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center, Guro Hospital, Seoul 08308, Republic of Korea
| | - Jung Yoon Choi
- Division of Medical Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center, Guro Hospital, Seoul 08308, Republic of Korea
| | - Hong Jun Kim
- Division of Medical Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center, Guro Hospital, Seoul 08308, Republic of Korea
| | - Suk-Young Lee
- Division of Medical Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center, Guro Hospital, Seoul 08308, Republic of Korea
| | - Eun Joo Kang
- Division of Medical Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center, Guro Hospital, Seoul 08308, Republic of Korea
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Wang JG, Liu B, Gao H, Li YJ, Zhao P, Liu XP. Primary Cardiac Osteosarcoma. Heart Lung Circ 2016; 25:698-704. [PMID: 26907617 DOI: 10.1016/j.hlc.2016.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/31/2015] [Accepted: 01/07/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Primary cardiac osteosarcoma is extremely rare. There is no cohort study on such tumours to date. The aim of this study is to investigate the clinical characteristics and outcome patterns of such tumours. METHODS A thorough literature review was performed, and all relevant clinical items were collected. A total of 53 cases of primary cardiac osteosarcoma were enrolled in this study, including 25 males and 28 females. RESULTS The age at diagnosis ranged from 14 to 77 years with a mean age of 43.6 years. The clinical manifestations, imaging features, and laboratory tests of the primary cardiac osteosarcomas were similar to other types of primary cardiac tumours. Sex, tumour size and adjunctive chemo-radiotherapy were found to affect the overall survival pattern. CONCLUSIONS The present study may provide an effective consultation for the diagnosis and treatment of this tumour.
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Affiliation(s)
- Ji-Gang Wang
- Department of Pathology, The Affiliated Hospital of Qingdao University, People's Republic of China; Department of Pathology, School of Basic Medical Sciences, Fudan University, People's Republic of China
| | - Bing Liu
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, People's Republic of China
| | - Han Gao
- Department of Pathology, Qingdao Municipal Hospital, People's Republic of China
| | - Yu-Jun Li
- Department of Pathology, The Affiliated Hospital of Qingdao University, People's Republic of China
| | - Peng Zhao
- Department of Pathology, The Affiliated Hospital of Qingdao University, People's Republic of China
| | - Xiu-Ping Liu
- Department of Pathology, The Fifth Peoples' Hospital of Shanghai, Fudan University, People's Republic of China; Department of Pathology, School of Basic Medical Sciences, Fudan University, People's Republic of China.
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Saisho C, Ishii H, Edakuni N, Imamura Y, Tokito T, Kinoshita T, Azuma K, Yamada K, Hoshino T. Sarcomatoid Type Primary Pericardial Mesothelioma with a Long-term Survival after the Onset of Cardiac Tamponade. Intern Med 2016; 55:3161-3164. [PMID: 27803412 PMCID: PMC5140867 DOI: 10.2169/internalmedicine.55.6300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Primary pericardial malignant mesothelioma is a very rare clinical entity and its prognosis is very poor. We herein report a 67-year-old man who presented with pericardial mesothelioma that was diagnosed 21 months after the onset of cardiac tamponade as the initial manifestation. Despite undergoing pericardiocentesis and surgical pericardial fenestration at the onset of cardiac tamponade, we were unable to make a conclusive diagnosis of mesothelioma based on the cytological and histological findings. This unusual case had a relatively long progression-free period without treatment before the appearance of pleural tumors that showed the histological features of malignant sarcomatoid mesothelioma.
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Affiliation(s)
- Chika Saisho
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
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Isoda R, Yamane H, Nezuo S, Monobe Y, Ochi N, Honda Y, Nishimura S, Akiyama M, Horio T, Takigawa N. Successful palliation for an aged patient with primary pericardial mesothelioma. World J Surg Oncol 2015; 13:273. [PMID: 26376726 PMCID: PMC4573695 DOI: 10.1186/s12957-015-0692-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/07/2015] [Indexed: 11/10/2022] Open
Abstract
An 85-year-old Japanese man with a complaint of exertional dyspnea was admitted to our hospital. Sixty-three years prior to admission at our hospital, he handled asbestos for 2 years in a factory. His chest computed tomography showed a massive pericardial effusion leading to cardiac tamponade and right pleural plaque. After a pericardiocentesis was performed, he recovered from cardiac failure caused by the cardiac tamponade. Pathological examination of the pericardial effusion revealed malignant mesothelial cells. Therefore, he was diagnosed with primary pericardial mesothelioma (PPM) related to asbestos exposure. Although his disease slowly progressed over 18 months, he remained active without any adjuvant treatments such as chemotherapy. Long-term palliation in an aged patient with PPM is rarely obtained using supportive care alone because the prognosis of PPM has been consistently reported to be very poor and almost fatal within a year. Clinical oncologists and thoracic surgeons should be aware of this disease because the accumulation of knowledge on PPM may lead to successful treatment even in aged patients.
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Affiliation(s)
- Ryutaro Isoda
- Clinical Education and Training Center, Kawasaki Hospital, Kawasaki Medical School, 2-1-80 Nakasange, Okayama, 700-8505, Japan
| | - Hiromichi Yamane
- Department of General Internal Medicine 4, Kawasaki Medical School, 2-1-80 Nakasange, Okayama, 700-8505, Japan.
| | - Shintaro Nezuo
- Department of General Internal Medicine 3, Kawasaki Medical School, 2-1-80 Nakasange, Okayama, 700-8505, Japan
| | - Yasumasa Monobe
- Department of Pathology 1, Kawasaki Medical School, 2-1-80 Nakasange, Okayama, 700-8505, Japan
| | - Nobuaki Ochi
- Department of General Internal Medicine 4, Kawasaki Medical School, 2-1-80 Nakasange, Okayama, 700-8505, Japan
| | - Yoshihiro Honda
- Department of General Internal Medicine 4, Kawasaki Medical School, 2-1-80 Nakasange, Okayama, 700-8505, Japan
| | - Satoshi Nishimura
- Department of General Internal Medicine 3, Kawasaki Medical School, 2-1-80 Nakasange, Okayama, 700-8505, Japan
| | - Maki Akiyama
- Department of General Internal Medicine 3, Kawasaki Medical School, 2-1-80 Nakasange, Okayama, 700-8505, Japan
| | - Takeshi Horio
- Department of General Internal Medicine 3, Kawasaki Medical School, 2-1-80 Nakasange, Okayama, 700-8505, Japan
| | - Nagio Takigawa
- Clinical Education and Training Center, Kawasaki Hospital, Kawasaki Medical School, 2-1-80 Nakasange, Okayama, 700-8505, Japan.,Department of General Internal Medicine 4, Kawasaki Medical School, 2-1-80 Nakasange, Okayama, 700-8505, Japan
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Gong W, Ye X, Shi K, Zhao Q. Primary malignant pericardial mesothelioma-a rare cause of superior vena cava thrombosis and constrictive pericarditis. J Thorac Dis 2015; 6:E272-5. [PMID: 25590007 DOI: 10.3978/j.issn.2072-1439.2014.11.36] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/23/2014] [Indexed: 11/14/2022]
Abstract
Primary malignant pericardial mesothelioma (PMPM) is an extremely rare, highly lethal and often misdiagnosed tumor. We report a 60-year-old woman complaining of dry cough, shortness of breath and exertional dyspnea due to a large pericardial effusion. The pericardial fluid volume declined after pericardiocentesis; analysis of the fluid revealed malignant cells and was negative for tuberculosis. Subsequently, the patient developed a compression of the superior vena cava and pericardial constriction. The patient's symptoms marginally improved after partial pericardiectomy, and a diagnosis of pericardial mesothelioma was made on pathology. However, her symptoms continued to aggravate, and she died 8 months after presentation. Pericardial mesothelioma should be discovered earlier to treat patients who develop repeatedly pericardial effusion after pericardiocentesis and pericardial tamponade or those develop constrictive pericarditis.
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Affiliation(s)
- Wenhui Gong
- 1 Department of Cardiac Surgery, Ruijin Hospital of Shanghai Jiaotong University School of Medicine, Shanghai 200025, China ; 2 Department of Cardio-thoracic Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Xiaofeng Ye
- 1 Department of Cardiac Surgery, Ruijin Hospital of Shanghai Jiaotong University School of Medicine, Shanghai 200025, China ; 2 Department of Cardio-thoracic Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Kaihu Shi
- 1 Department of Cardiac Surgery, Ruijin Hospital of Shanghai Jiaotong University School of Medicine, Shanghai 200025, China ; 2 Department of Cardio-thoracic Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Qiang Zhao
- 1 Department of Cardiac Surgery, Ruijin Hospital of Shanghai Jiaotong University School of Medicine, Shanghai 200025, China ; 2 Department of Cardio-thoracic Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
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Quintero V, Múnera AG, Arroyave JA, Duque M. Mesotelioma pericárdico primario manifestado como derrame pericárdico severo. REVISTA COLOMBIANA DE CARDIOLOGÍA 2015. [DOI: 10.1016/j.rccar.2015.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ashinuma H, Shingyoji M, Yoshida Y, Itakura M, Ishibashi F, Tamura H, Moriya Y, Itami M, Tatsumi K, Iizasa T. Endobronchial ultrasound-guided transbronchial needle aspiration in a patient with pericardial mesothelioma. Intern Med 2015; 54:43-8. [PMID: 25742892 DOI: 10.2169/internalmedicine.54.3216] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pericardial mesothelioma is a very rare pericardial tumor. Diagnosing pericardial disease can be challenging, and obtaining an antemortem diagnosis of pericardial mesothelioma is particularly difficult. We herein report the case of a 60-year-old man with pericardial mesothelioma diagnosed on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Chest computed tomography showed a mass surrounding the pericardium, and EBUS-TBNA of the right inferior paratracheal and subcarinal stations was consequently performed. No uptake was noted on (18)F-fluorodeoxy glucose positron emission tomography, other than in the pericardial mass. The results of histological and immunohistochemical examinations indicated the features of malignant mesothelioma. We therefore diagnosed the patient with pericardial mesothelioma, which was subsequently confirmed at autopsy.
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Restrepo CS, Vargas D, Ocazionez D, Martínez-Jiménez S, Betancourt Cuellar SL, Gutierrez FR. Primary pericardial tumors. Radiographics 2014; 33:1613-30. [PMID: 24108554 DOI: 10.1148/rg.336135512] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary pericardial tumors are rare and may be classified as benign or malignant. The most common benign lesions are pericardial cysts and lipomas. Mesothelioma is the most common primary malignant pericardial neoplasm. Other malignant tumors include a wide variety of sarcomas, lymphoma, and primitive neuroectodermal tumor. When present, signs and symptoms are generally nonspecific. Patients often present with dyspnea, chest pain, palpitations, fever, or weight loss. Although the imaging approach usually begins with plain radiography of the chest or transthoracic echocardiography, the value of these imaging modalities is limited. Cross-sectional imaging, on the other hand, plays a key role in the evaluation of these lesions. Computed tomography and magnetic resonance imaging allow further characterization and may, in some cases, provide diagnostic findings. Furthermore, the importance of cross-sectional imaging lies in assessing the exact location of the tumor in relation to neighboring structures. Both benign and malignant tumors may result in compression of vital mediastinal structures. Malignant lesions may also directly invade structures, such as the myocardium and great vessels, and result in metastatic disease. Imaging plays an important role in the detection, characterization, and staging of pericardial tumors; in their treatment planning; and in the posttreatment follow-up of affected patients. The prognosis of patients with benign tumors is good, even in the few cases in which surgical intervention is required. On the other hand, the length of survival for patients with malignant pericardial tumors is, in the majority of cases, dismal.
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Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center, San Antonio, Tex
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Jodati A, Kazemi B, Safaei N, Toufan M. A Ball in the Heart: An Interesting Discovery in a Very RareCardiac Tumor. J Cardiovasc Thorac Res 2013; 5:77-80. [PMID: 24251017 DOI: 10.5681/jcvtr.2013.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 06/06/2013] [Indexed: 11/17/2022] Open
Abstract
Primary pericardial malignant mesothelioma is an extremely rare tumor even among all mesotheliomas with about 350 cases reported in the literature so far. Typically, it has an insidious presentation, with nonspecific signs and symptoms, and usually results in constrictive pericarditis, cardiac tamponade or congestive heart failure through either a massive effusion or direct tumurous constriction or invasion to the heart. With the exception of several case reports, the outcome is uniformly dismal and patients typically die within six months of diagnosis. We report a 24 year old male with long history of pleuretic chest paint and admissions with a diagnosis of idiopathic pericarditis, eventually presenting with increasing symptoms of heart failure and a large mobile ball like mass in the heart at echocardiographic and computed tomography studies. At operation, an atypical invasive cardiac tumor was discovered. Complete resection of the tumor was impossible and the patient died from progression of the disease 4 months later.
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Affiliation(s)
- Ahmadreza Jodati
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Smets P, Guettrot-Imbert G, Hermet M, Delevaux I, Kemeny JL, Aumaître O, André M. Péricardite récidivante : traquer le mésotheliome péricardique primitif. Rev Med Interne 2013; 34:573-6. [DOI: 10.1016/j.revmed.2013.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 04/05/2013] [Accepted: 04/26/2013] [Indexed: 12/26/2022]
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Primary pericardial mesothelioma: a rare entity. Case Rep Oncol Med 2013; 2013:283601. [PMID: 23840993 PMCID: PMC3697233 DOI: 10.1155/2013/283601] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 06/05/2013] [Indexed: 11/30/2022] Open
Abstract
Primary pericardial malignant mesothelioma is an extremely rare neoplasm that arises from the pericardial mesothelial cell layers. Clinical symptoms and signs are frequently nonspecific, and the diagnosis is usually made after surgery or at autopsy. There is no standard treatment for pericardial mesothelioma; nonetheless, radical surgery is the mainstay of therapy for localized disease. The neoplasm is highly aggressive and carries a dismal prognosis with an overall survival of less than six months. This paper presents a case study of a 68-year-old patient with a primary pericardial malignant mesothelioma. Radiologic evaluation revealed a small nodule in the posterior pericardium with pericardial and bilateral pleural effusions. The diagnosis was established after surgery by histological and immunohistochemical studies. The patient remained alive and free of disease for about 24 months; however, due to rapid local recurrence, the patient died 27 months after the surgical treatment.
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Fujita K, Hata M, Sezai A, Minami K. Three-year survival after surgery for primary malignant pericardial mesothelioma: report of a case. Surg Today 2013; 44:948-51. [PMID: 23408086 DOI: 10.1007/s00595-013-0511-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 10/15/2012] [Indexed: 12/17/2022]
Abstract
A 59-year-old female underwent surgery for a primary malignant pericardial mesothelioma. She presented with progressive dyspnea, and several imaging studies demonstrated a 65 × 22 mm tumor in the aortopulmonary window, accompanied by massive pericardial effusion. The tumor was successfully excised with clean surgical margins under cardiopulmonary bypass, followed by patch reconstruction of the pulmonary artery, and was diagnosed as an epithelioid type of malignant pericardial mesothelioma. The patient tolerated the operation and subsequent adjuvant chemotherapy without any complications. She remained alive and asymptomatic for almost 3 years after surgery, despite the fact that the median survival of this disease is 6-10 months. This patient is the second longest postoperative survivor of this extremely rare, aggressive neoplasm.
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Affiliation(s)
- Kishu Fujita
- Department of Cardiovascular Surgery, Kitakanto Jyunkanki Hospital, 740 Shimohakoda, Hokkitsumachi, Shibukawa, Gunma, 377-0061, Japan,
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Ramos V, Vieira C, Fernandes N, Nunes Gonçalves F, Salgado A, Correia A. Causa rara de doença pericárdica. Rev Port Cardiol 2013; 32:149-52. [DOI: 10.1016/j.repc.2012.05.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 04/19/2012] [Accepted: 05/03/2012] [Indexed: 11/29/2022] Open
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Ramos V, Vieira C, Fernandes N, Gonçalves FN, Salgado A, Correia A. A rare cause of pericardial disease. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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