Cardiac tamponade due to primary malignant pericardial mesothelioma diagnosed with surgical pericardial resection

Naoki Kawakami; Miki Kawai; Ho Namkoong; Daisuke Arai; Soichiro Ueda; Kenichi Hamada; Ichiro Kawada; Naoki Hasegawa; Shuji Mikami; Hisao Asamura; Koichi Fukunaga

doi:10.1016/j.jccase.2021.03.002

Cardiac tamponade due to primary malignant pericardial mesothelioma diagnosed with surgical pericardial resection

J Cardiol Cases. 2021 Apr 8;24(4):149-152. doi: 10.1016/j.jccase.2021.03.002. eCollection 2021 Oct.

Authors

Naoki Kawakami¹, Miki Kawai^{2

3}, Ho Namkoong^{2

4}, Daisuke Arai², Soichiro Ueda², Kenichi Hamada⁵, Ichiro Kawada², Naoki Hasegawa⁶, Shuji Mikami⁷, Hisao Asamura⁵, Koichi Fukunaga²

Affiliations

¹ Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan.
² Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
³ Division of Endocrinology, Metabolism, and Nephrology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
⁴ Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD 20852, USA.
⁵ Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan.
⁶ Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan.
⁷ Department of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan.

Abstract

Primary malignant pericardial mesothelioma is an extremely rare disease. Malignant disease of the pericardium is an infrequent cause of cardiac tamponade. Hence, cardiac tamponade in the context of primary malignant mesothelioma of the pericardium is an uncommon clinical scenario. A 67-year-old male patient, an ex-smoker, complaining of progressive lethargy was referred to a hospital for investigation of persistent pericardial effusion. The pericardial fluid cytology was categorized as class Ⅲ. Thereafter, he was referred to our hospital for further evaluation. Fluorodeoxyglucose (FDG) positron emission tomography (PET) revealed FDG accumulation in the pericardium and mediastinal lymph node. Surgical biopsy of the pericardium was performed through a subxiphoid approach for a definitive diagnosis. Histopathological examination revealed diffuse infiltration of the pericardium by a malignant tumor consisting of epithelioid cells with large round nuclei and prominent nucleoli, arranged in a tubular papillary pattern. Finally, the patient was diagnosed with primary malignant pericardial mesothelioma of epithelioid type. The patient died 6 weeks after admission. This diagnosis must be considered in patients having unexplained massive pericardial effusion. Furthermore, we should consider prompt cytological analysis and FDG PET to arrive rapidly at a definitive diagnosis to administer combination chemotherapy that may provide clinical benefit. <Learning objective: Primary malignant pericardial mesothelioma is a rare disease. Malignant disease of the pericardium is an infrequent cause of cardiac tamponade. Hence, cardiac tamponade in the context of primary malignant mesothelioma of the pericardium is an uncommon clinical scenario. However, this diagnosis must be considered in patients having unexplained massive pericardial effusion. Furthermore, we should consider prompt cytological analysis and fluorodeoxyglucose positron emission tomography to arrive rapidly at a definitive diagnosis to administer combination chemotherapy that may provide clinical benefit.>.

Keywords: Cardiac tamponade; Primary malignant pericardial mesothelioma; Surgical pericardial resection.

Publication types

Case Reports