The New England Journal of Medicine; Boston Vol. 325, Iss. 11, (Sep 12, 1991): 814-814. DOI:10.1056/NEJM199109123251115
To the Editor: Primary pericardial mesothelioma is a rare disease. Mirabella* reviewed 206 cases reported from 1875 to 1978. We wish to report two cases of primary pericardial mesothelioma in Slovenia.
A 44-year-old man had dyspnea for two years before the onset of ankle swelling, belching, epigastric pain, fever, and cardiac tamponade. A chest x-ray film showed marked enlargement of the cardiac silhouette without pleural effusion. Hemorrhagic fluid was evacuated from the pericardium, yet cytologic studies failed to identify the cause of the pericarditis. Neither echocardiography nor cardiac catheterization clarified the cause. Antituberculous therapy, started on the basis of a positive tuberculin test, produced only temporary improvement, possibly due to the added prednisone. On surgical exploration, extensive nodular masses were discovered, extending over the pericardial surface. The pericardial cavity was filled with 5 to 8 mm of a thick, placenta-like tissue, adhering firmly to the heart. The diagnosis of primary pericardial mesothelioma was confirmed by the histologic findings. Two weeks after being placed on external-beam radiation therapy, the patient died suddenly. The autopsy revealed extensive tumor extending from the myocardium and pericardium to the pleura and mediastinum, as well as thromboembolism of both pulmonary arteries.
A 67-year-old man was admitted because of dyspnea at rest, cyanosis, ankle swelling, and fever. Heart failure was suspected, but the echocardiographic examination revealed marked pericardial effusion. Three days after admission, cardiac tamponade occurred. Pericardiocentesis yielded hemorrhagic fluid containing adenocarcinoma-like cells. Six months after the onset of symptoms, the patient died suddenly of pulmonary embolism. The histologic analysis confirmed the diagnosis of primary pericardial mesothelioma.
In both patients, primary pericardial mesothelioma was discovered by direct visualization, either during surgery or at autopsy. The symptoms were attributed not only to pericardial involvement but also to congestive heart failure due to myocardial infiltration.
*. Mirabella F. Contributo all’epidemiologia del mesothelioma pericardico. Pathologica 1982;1030:215 -29
Josip Turk M.D.
Miran Kenda M.D.
Igor Kranjec M.D.
University Medical Center, 61000 Ljubljana, Yugoslavia
Copyright Massachusetts Medical Society Sep 12, 1991