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Journal of Clinical Ultrasound : JCU Mar 2019Primary 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...
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.
Topics: Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Echocardiography; Heart Neoplasms; Humans; Lung Neoplasms; Male; Mesothelioma; Mesothelioma, Malignant; Middle Aged; Pemetrexed; Pericardium
PubMed: 30450660
DOI: 10.1002/jcu.22673 -
Thoracic Surgery Clinics Nov 2020Extrapleural pneumonectomy (EPP) is the most extensive form of surgery for mesothelioma, involving en bloc resection of visceral and parietal pleura, lung, diaphragm and... (Review)
Review
Extrapleural pneumonectomy (EPP) is the most extensive form of surgery for mesothelioma, involving en bloc resection of visceral and parietal pleura, lung, diaphragm and pericardium, with reconstruction of the pericardium and diaphragm. It can be performed safely in carefully selected patients. It should be performed in experienced centers as part of a multimodality treatment plan. The SMART approach, with a short course of induction hemithoracic radiation followed by EPP has demonstrated safety and value of hypofractionated hemithoracic radiation combined with complete macroscopic resection. We are conducting a clinical trial with oligofractionated hemithoracic radiation in early-stage mesothelioma.
Topics: Combined Modality Therapy; Diaphragm; Humans; Lung; Mesothelioma, Malignant; Neoadjuvant Therapy; Pericardium; Pleura; Pleural Neoplasms; Pneumonectomy; Plastic Surgery Procedures
PubMed: 33012433
DOI: 10.1016/j.thorsurg.2020.08.004 -
Pediatric and Developmental Pathology :... 2021Malignant mesothelioma is a neoplasm of serosal surfaces, most commonly affecting the pleura. The peritoneum, pericardium, and tunica vaginalis are less frequently...
Malignant mesothelioma is a neoplasm of serosal surfaces, most commonly affecting the pleura. The peritoneum, pericardium, and tunica vaginalis are less frequently involved. Malignant mesothelioma with fusion in young adults was recently reported in the literature. Here, we present two pediatric cases of translocation-associated malignant mesothelioma in the peritoneum and pericardium respectively. Both cases lacked a known exposure history. Microscopy in both cases showed predominantly epithelioid morphology with ample eosinophilic cytoplasm, and immunohistochemistry was positive for pan-keratin, calretinin, and WT1. Both cases showed gene rearrangement by RNA sequencing, which was instrumental in confirming the diagnosis of malignant mesothelioma and to exclude more common pediatric sarcomas, especially in the context of limited sampling.
Topics: Adolescent; Child; Gene Fusion; Humans; Immunohistochemistry; In Situ Hybridization, Fluorescence; Male; Mesothelioma; Mesothelioma, Malignant; Oncogene Proteins, Fusion; RNA-Binding Protein EWS; Young Adult
PubMed: 34121509
DOI: 10.1177/10935266211021222 -
Herz Feb 2018Malignant 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.
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.
Topics: Clinical Trials as Topic; Combined Modality Therapy; Diagnosis, Differential; Heart Neoplasms; Humans; Lung Neoplasms; Mesothelioma; Mesothelioma, Malignant; Palliative Care; Pericardium; Prognosis
PubMed: 28130567
DOI: 10.1007/s00059-016-4522-5 -
Cancers Nov 2022Malignant Mesothelioma (MM) is an aggressive neoplasm of the pleural mesothelium, less frequently peritoneal and exceptionally of the vaginal tunic of the testicle and...
Malignant Mesothelioma (MM) is an aggressive neoplasm of the pleural mesothelium, less frequently peritoneal and exceptionally of the vaginal tunic of the testicle and pericardium [...].
PubMed: 36428633
DOI: 10.3390/cancers14225540 -
World Neurosurgery Jun 2018Malignant mesotheliomas are aggressive and rapidly fatal neoplasms arising from the mesothelial cells. The most common sites of origin are the pleural and peritoneal... (Review)
Review
BACKGROUND
Malignant mesotheliomas are aggressive and rapidly fatal neoplasms arising from the mesothelial cells. The most common sites of origin are the pleural and peritoneal cavities; the pericardium and the tunica vaginalis are infrequently involved, and malignant mesothelioma in the spinal canal is extremely rare. Here we report a case of primary spinal malignant mesothelioma. We also report the results of a literature search conducted in PubMed with specific key terms, inclusion criteria, and exclusion criteria, with a comparison of elected case studies and case series, and statistical analysis as appropriate.
CASE DESCRIPTION
A 35-year-old man presented with a 3-month history of swelling and pain in the left lower extremity. Neurologic examination revealed a loss of sensation below the L5 dermatome. Magnetic resonance imaging (MRI) showed a mass at the L4-5 level. A diagnosis of schwannoma was suspected, and surgical resection was performed. Histopathological findings were consistent with sarcomatoid malignant mesothelioma. Thoracic and whole-abdomen computed tomography yielded normal results. The patient refused adjuvant radiotherapy or chemotherapy. Positron emission tomography-computed tomography performed at 3 months postoperatively showed no abnormality. At 8 months postoperatively, the patient developed back pain and difficulty with defecation; MRI demonstrated tumor recurrence. During a second operation, invasion of the vertebra and cauda equina was noted. A subtotal resection was achieved, and the pain was partially alleviated. Two months later, the patient succumbed to a traffic accident.
CONCLUSIONS
Spinal malignant mesothelioma is an extremely rare but highly aggressive entity. Preoperative identification is challenging, and definitive diagnosis depends on histopathological evidence. Surgical resection can help relieve the symptoms, but the overall prognosis is poor.
Topics: Adult; Humans; Lung Neoplasms; Male; Mesothelioma; Mesothelioma, Malignant; Spinal Neoplasms
PubMed: 29588242
DOI: 10.1016/j.wneu.2018.03.124 -
Korean Circulation Journal Jun 2022
PubMed: 35656906
DOI: 10.4070/kcj.2022.0060 -
Cureus Nov 2021Primary 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...
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.
PubMed: 34984126
DOI: 10.7759/cureus.19966 -
Interactive Cardiovascular and Thoracic... Aug 2020Primary malignancies arising from the pericardium are rare, even more unusual for primary pericardial mesothelioma. The diagnosis is difficult and has no standard...
Primary malignancies arising from the pericardium are rare, even more unusual for primary pericardial mesothelioma. The diagnosis is difficult and has no standard treatment. We herein present a case of a 65-year-old woman with primary pericardial mesothelioma associated with dyspnoea and palpitations. Transthoracic conventional echocardiography revealed mild pericardial effusion and a hypo-echogenic mass in the pericardium. Contrast echocardiography showed that the mass was hyper-enhanced with a radial enhancement pattern. The patient underwent open chest exploration and was diagnosed by pathological examination. She had no further treatment and died 2 years later. In conclusion, the combination of conventional echocardiography and contrast echocardiography plays a significant role in diagnosing primary pericardial mesothelioma. Comprehensive evaluation and accurately preoperative diagnosis are important to exclude certain tumours that do not require surgery.
Topics: Aged; Cardiac Surgical Procedures; Contrast Media; Diagnosis, Differential; Echocardiography; Female; Heart Neoplasms; Humans; Mesothelioma; Mesothelioma, Malignant; Pericardium
PubMed: 32542336
DOI: 10.1093/icvts/ivaa081 -
Case Reports in Medicine 2016This 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...
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.
PubMed: 28003826
DOI: 10.1155/2016/4810901