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.
Highlights
Primary cardiac tumors of heart are uncommon, whereas primary pericardial mesothelioma (PPM) is exceptionally rare with an incidence of only 0.0022% in a series of nearly 500,000 random autopsies [1]
PPM accounts for 2-3% of the primary heart and pericardial tumors; it is the third tumor after angiosarcoma (33%) and rhabdomyosarcoma (20%) [2]
The diagnosis of PPM is usually difficult and late, and in the majority of cases, the diagnosis of PPM is typically made at autopsy [3]
Summary
Primary cardiac tumors of heart are uncommon, whereas primary pericardial mesothelioma (PPM) is exceptionally rare with an incidence of only 0.0022% in a series of nearly 500,000 random autopsies [1]. The diagnosis of PPM is usually difficult and late, and in the majority of cases, the diagnosis of PPM is typically made at autopsy [3]. Owing to poor response to existing systemic and radiation therapy, radical surgery remains the cornerstone of treatment in an attempt to cure the localized disease. The neoplasm is very aggressive, and the prognosis has been uniformly dismal for the only handful of reported cases surviving more than 1 year after diagnosis. We describe a 68-year-old man who underwent surgery for localized pericardial mass found on radiologic assessment, and subsequently diagnosed as PPM. Twenty-seven months after surgery, the patient died due to local recurrence
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