Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2022; 10(33): 12380-12387
Published online Nov 26, 2022. doi: 10.12998/wjcc.v10.i33.12380
Primary malignant pericardial mesothelioma with difficult antemortem diagnosis: A case report
Naoya Oka, Yuichi Orita, Chikage Oshita, Hirofumi Nakayama, Hiroki Teragawa
Naoya Oka, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima 734-8551, Japan
Yuichi Orita, Chikage Oshita, Hiroki Teragawa, Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
Hirofumi Nakayama, Department of Pathology, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
Author contributions: Oka N, Orita Y, Oshita C and Teragawa H were the patient’s physicians, reviewed the literature and contributed to manuscript drafting; Nakayama H performed the histopathological analyses and interpretation and contributed to manuscript drafting; all authors issued final approval for the version to be submitted.
Informed consent statement: Written informed consent was obtained from the patient for the autopsy and the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hiroki Teragawa, FACC, FACP, FAHA, FESC, MD, PhD, Chief Physician, Doctor, Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima 732-0057, Japan. hiroki-teragawa@jrhh.or.jp
Received: August 17, 2022
Peer-review started: August 17, 2022
First decision: September 5, 2022
Revised: September 19, 2022
Accepted: October 26, 2022
Article in press: October 26, 2022
Published online: November 26, 2022
Processing time: 97 Days and 19.4 Hours
Abstract
BACKGROUND

Primary malignant pericardial mesothelioma (PMPM) is an extremely rare malignant tumor, and it is difficult to diagnose definitively before death. We present a case in which PMPM was diagnosed at autopsy. We consider this case to be highly suggestive and report it here.

CASE SUMMARY

A 78-year-old male presented with transient loss of consciousness and falls. The transient loss of consciousness was considered to result from complications of diastolic dysfunction due to pericardial disease, fever with dehydration, and paroxysmal atrial fibrillation. Ultrasound cardiography (UCG) and computed tomography showed cardiac enlargement and high-density pericardial effusion. We considered pericardial disease to be the main pathogenesis of this case. Cardiac magnetic resonance imaging and gadolinium contrast-enhanced T1-weighted images showed thick staining inside and outside the pericardium. Pericardial biopsy was considered to establish a definitive diagnosis, but the patient and his family refused further treatment and examinations, and the patient was followed conservatively. We noticed a thickening of the pericardium and massive changes in the pericardium on UCG over time. We performed an autopsy 60 h after the patient died of pneumonia. Giemsa staining of the autopsy tissue showed an epithelial-like arrangement in the pericardial tumor, and immunostaining showed positive and negative factors for the diagnosis of PMPM. Based on these findings, the final diagnosis of PMPM was made.

CONCLUSION

PMPM has a poor prognosis, and early diagnosis and treatment are important. The temporal echocardiographic findings may provide a clue for the diagnosis of PMPM.

Keywords: Primary malignant pericardial mesothelioma; Antemortem diagnosis; Pericardial disease; Temporal echocardiographic; Case report

Core Tip: Primary malignant pericardial mesothelioma (PMPM) is an extremely rare malignant tumor that is difficult to diagnose definitively before death. We encountered a case of PMPM that could not be diagnosed before death. A 78-year-old male was admitted to our emergency department with the chief complaint of loss of consciousness. In his lifetime, PMPM had not been listed as a differential diagnosis based on several imaging examinations, but it was eventually diagnosed at autopsy. Imaging findings on ultrasound cardiography may aid in the antemortem diagnosis of PMPM, which is one of the differential diagnoses for pericardial disease.