J Korean Med Sci.  2017 Nov;32(11):1879-1884. 10.3346/jkms.2017.32.11.1879.

A Case Report of Primary Pericardial Malignant Mesothelioma Treated with Pemetrexed and Cisplatin

• Kim JS
• Lim SY
• Hwang J
• Kang EJ
• Choi YJ

• KMID: 2390319
• DOI: http://doi.org/10.3346/jkms.2017.32.11.1879

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.

Keyword

Primary Pericardial Mesothelioma; Cardiac Tamponade; Pemetrexed; Cisplatin

MeSH Terms

Aged
Asbestos
Cardiac Tamponade
Cisplatin*
Disease Progression
Drug Therapy
Female
Humans
Incidence
Mesothelioma*
Pemetrexed*
Pericardial Effusion
Prognosis
Treatment Outcome
Asbestos
Cisplatin
Pemetrexed

Figure

• 

  Fig.1 Initial imaging studies of first admission. (A) Chest radiography showed no cardiomegaly. (B) Chest CT showed a moderate amount of pericardial effusion. (C) TTE demonstrated a normal cardiac contractile force (60%–65%) and a moderate amount of pericardial effusion. CT = computed tomography, TTE = transthoracic echocardiography.

• 

  Fig. 2 Follow-up imaging studies of second admission diagnosed with PPM. (A) Chest radiography showed a severe cardiomegaly. (B) Chest CT showed a huge mediastinal mass that bordered by ascending aorta, SVC and right pulmonary artery. (C) TTE demonstrated a normal cardiac contractile force (55%–60%) and a large amount of pericardial effusion. (D) PET revealed a mass showing an abnormal hypermetabolism in the mediastinum. PPM = primary pericarcial malignant mesothelioma, SVC = superior vena cava, CT = computed tomography, TTE = transthoracic echocardiography, PET = positron emission tomography.

• 

  Fig. 3 Histological findings. (A) Monotonous atypical epithelioid cells proliferation (× 200). (B) Tubulopapillary structure (× 200). (C) Immunohistochemical stain of calretinin (× 400). (D) Immunohistochemical stain of WT1 (× 400). WT1 = Wilms tumor 1.

• 

  Fig. 4 Kaplan-Meier curve of overall survival of 24 patients with pericardial malignant mesothelioma (1234678911121314151617181920).

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