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Steber C, Farris J, Hughes RT, Helis CA, Naal T, Kim-Shapiro JW, Jacobson T, Farris MK. Malignant Pericardial Mesothelioma Treated Using Volumetric Modulated Arc Therapy With a Simultaneous Integrated Boost. Adv Radiat Oncol 2020; 6:100562. [PMID: 33490725 PMCID: PMC7811119 DOI: 10.1016/j.adro.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/13/2020] [Accepted: 09/12/2020] [Indexed: 12/04/2022] Open
Affiliation(s)
- Cole Steber
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Joshua Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Corbin A Helis
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Tawfeq Naal
- Department of Pathology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Jung W Kim-Shapiro
- Department of Pathology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Travis Jacobson
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Michael K Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
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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: 0.6] [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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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: 33] [Impact Index Per Article: 4.7] [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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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: 2.4] [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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Pericardial Effusion due to Primary Malignant Pericardial Mesothelioma: A Common Finding but an Uncommon Cause. Case Rep Med 2016; 2016:4810901. [PMID: 28003826 PMCID: PMC5149636 DOI: 10.1155/2016/4810901] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 12/22/2022] Open
Abstract
This case report describes a 37-year-old female who was admitted to our Emergency Department because of shortness of breath. On physical examination, she had dyspnea and tachycardia and blood pressure was 80/50 mmHg with a pulsus paradoxus of 22 mmHg. Neck veins were distended, heart sounds were distant, and dullness was found on both lung bases. Her chest X-ray revealed bilateral pleural effusion and cardiomegaly. On both computed tomography and echocardiography the heart was of normal size and a large pericardial effusion was noted. The echocardiogram showed signs of impending tamponade, so the patient underwent an emergent pericardiocentesis. No infectious etiology was found and she was assumed to have viral pericarditis and was treated accordingly. However, when the pericardial effusion recurred and empirical therapy for tuberculosis failed, a pericardial window was performed. A typical staining pattern for mesothelioma was found on her pericardial biopsy specimen. Since no other mesodermal tissue was affected, a diagnosis of primary malignant pericardial mesothelioma was made. Chemotherapy was not effective and she passed away a year after the diagnosis was made. This case highlights the difficulties in diagnosing this uncommon disease in patients that present with the common finding of pericardial effusion.
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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: 0.9] [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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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: 0.8] [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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Fernandes R, Nosib S, Thomson D, Baniak N. A rare cause of heart failure with preserved ejection fraction: primary pericardial mesothelioma masquerading as pericardial constriction. BMJ Case Rep 2014; 2014:bcr-2013-203194. [PMID: 24654246 DOI: 10.1136/bcr-2013-203194] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
We present a case of a 30-year-old woman with a history of HIV and hepatitis C who sought medical attention because of severe oedema of the lower limbs and abdomen. CT of the chest showed a thickened pericardium, and cardiac catheterisation demonstrated constrictive physiology. She underwent pericardiectomy, but the procedure was unsuccessful because the pericardium was densely adherent to the myocardium. After consultation with several pathologists, she was diagnosed with primary pericardial mesothelioma (PPM), an exceedingly rare cardiac tumour with a fatal prognosis. She died within 3 months of presentation. The details of the case as well as pertinent literature are reviewed.
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Affiliation(s)
- Russell Fernandes
- Department of Internal Medicine, University of Saskatchewan, Saskatoon, Canada
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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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Affiliation(s)
- Shinichi Taguchi
- Department of Cardiovascular Surgery; Keio University Hospital; Tokyo Japan
| | - Ryohei Yozu
- Department of Cardiovascular Surgery; Keio University Hospital; Tokyo Japan
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Nana A, Vorilhon C, Adjtoutah D, Azarnoush K, Kissel V, Chabin X, Chailloux A, Belhakem A, Tixier V, Ferrier N, Croisille P, Long JL, Marcaggi X. [Contribution of magnetic resonance imaging in diagnosis of pericardial mesothelioma: a case report]. Ann Cardiol Angeiol (Paris) 2012; 61:370-4. [PMID: 22959437 DOI: 10.1016/j.ancard.2012.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 08/07/2012] [Indexed: 11/17/2022]
Abstract
Pericardial mesothelioma is a rare form of pericardial tumor. The invasive investigations such as biopsy make the diagnosis. Non-invasive imaging techniques provide valuable information about its diagnosis and its clinical impact. We report here the results of magnetic resonance imaging of pericardial mesothelioma in a 65-year-old woman. The originality and purpose of this case is to illustrate the additional value of magnetic resonance imaging that should be systematically performed when assessing this pathology.
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Affiliation(s)
- A Nana
- Unité de réanimation polyvalente et soins intensifs cardiaques, médecine interne et cardiologie, centre hospitalier Jacques-Lacarin, boulevard Denière, 03207 Vichy, France
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12
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Feng X, Zhao L, Han G, Khalil M, Green F, Ogilvie T, Krause V. A case report of an extremely rare and aggressive tumor: primary malignant pericardial mesothelioma. Rare Tumors 2012; 4:e21. [PMID: 22826778 PMCID: PMC3401149 DOI: 10.4081/rt.2012.e21] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 03/02/2012] [Accepted: 03/03/2012] [Indexed: 11/22/2022] Open
Abstract
Primary pericardial malignant mesothelioma (PMPM) is extremely rare with an incidence less than 0.0022%. It comprises 0.7% of all mesothelioma cases. To date, approximately 350 cases of pericardial mesothelioma have been reported in the literature. Its typical presentation is insidious, with nonspecific signs and symptoms, and usually results in constrictive pericarditis, cardiac tamponade and congestive heart failure either by a serous effusion or by direct tumorous constriction of the heart. With the exception of several case reports, the outcome is uniformly fatal, and patients typically die within six months of diagnosis. Here we report a 72-year-old Cauca -sian male with persistent pericardial and pleural effusion. He was diagnosed with PMPM after pericardectomy. He had only one cycle of chemotherapy with cisplatin and pemetrexed. He developed acute kidney injury as result of chemotherapy. He died 1 month after diagnosis and 6 months after the first symptoms.
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Affiliation(s)
- Xiaolan Feng
- Internal Medicine Residency Training Program, Department of Medicine
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