Comprehensive treatment of a rare primary malignant pericardial mesothelioma: A case report and literature review

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Primary malignant pericardial mesothelioma (n=1). Intervention: Comprehensive treatment (pemetrexed plus cisplatin chemotherapy, supportive care, and partial pericardial resection). Primary outcome: Disease progression and symptom recurrence postoperatively.

Q: What does this research mean for the field?

Comprehensive multimodal treatment combining chemotherapy, supportive care, and timely surgical intervention is effective for managing unresectable primary malignant pericardial mesothelioma. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Chun‐Yu Liu; Bin Zhao; Weiwei Cheng; Dongliang Ma; Shunye Zhang

doi:10.21203/rs.3.rs-1692443/v1

June 1, 2022Open Access

Comprehensive treatment of a rare primary malignant pericardial mesothelioma: A case report and literature review

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Why the study?

Primary malignant pericardial mesothelioma is an extremely rare and aggressive malignancy with nonspecific symptoms that is usually found incidentally and considered extremely fatal despite treatment.

Key Points

To report the management and clinical outcomes of an asymptomatic patient with unresectable primary malignant pericardial mesothelioma treated with multimodal therapy.
Evaluated an asymptomatic 64-year-old female diagnosed with primary malignant pericardial mesothelioma via positron emission tomography/computed tomography (PET/CT).
Administered 22 months of supportive therapy and systemic chemotherapy, followed by urgent surgical excision upon presentation with progressive dyspnea, and resumed postoperative chemotherapy.
Surgical biopsy demonstrated pericardial thickening, poorly circumscribed masses, friable tissue, and necrosis, pathologically confirming epithelium-like malignant mesothelioma.
At 7 months postoperatively, the patient exhibited no recurrence of dyspnea, and follow-up PET/CT confirmed no disease progression.

Study Design

Type

Case Report (n=1)

Multicenter

No

PICO

P

Population

A 64-year-old woman with primary malignant pericardial mesothelioma treated with chemotherapy, supportive care, and delayed partial surgical resection, followed for 29 months.

I

Intervention / Comparator

Comprehensive treatment (pemetrexed plus cisplatin chemotherapy, supportive care, and partial pericardial resection) (Pemetrexed 500 mg/m2 reduced to 250 mg/m2 and 125 mg/m2; Cisplatin 75 mg/m2 reduced to 37.5 mg/m2 and 18.75 mg/m2)

O

Primary Outcome

Disease progression and symptom recurrence postoperatively

Limitations

Single patient case report
Standardized guidelines for the treatment of primary malignant pericardial mesothelioma are lacking
Insufficient evidence regarding the effects of radiotherapy and chemotherapy on this disease entity
Poor diagnostic effect of pericardiocentesis and pericardial effusion analysis on malignant pericardial tumours

Implication

Case report demonstrates multimodal therapy and timely surgery stabilize primary malignant pericardial mesothelioma in a patient, highlighting the importance of urgent intervention.

Abstract

Background: Primary malignant pericardial mesothelioma (PMPM) is an extremely rare aggressive malignancy with nonspecific symptoms; thus, cases of PMPM are usually found incidentally. Despite treatment, it is considered extremely fatal.Case presentation: We encountered an asymptomatic 64-year-old woman diagnosed with PMPM by positron emission tomography/computed tomography (PET/CT). After 22 months of supportive treatment and chemotherapy, she presented to our facility with progressive dyspnoea. Surgery was performed. Excision biopsy showed thickening pericardium and many poorly circumscribed masses, and cut sections showed friable grey–white tissue with areas of necrosis. Pathological examination confirmed epithelium-like malignant mesothelioma. The patient was continuously treated with a previously prescribed chemotherapy regimen. The patient did not exhibit dyspnoea recurrence, and PET/CT showed no progression 7 months postoperatively.Conclusion: Comprehensive treatment, including chemotherapy, supportive treatment, and timely surgery, is effective for unresectable PMPM. When patients present with symptoms caused by PMPM that are not relieved by medication, we recommend prioritising urgent surgery.

Discussion

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Cite This Study

Liu et al. (2022) conducted a case report in Primary malignant pericardial mesothelioma (n=1). Comprehensive treatment (pemetrexed plus cisplatin chemotherapy, supportive care, and partial pericardial resection) was evaluated on Disease progression and symptom recurrence postoperatively.

synapsesocial.com/papers/6ae44a73fd77a9a4e7238b68 https://doi.org/10.21203/rs.3.rs-1692443/v1

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Comprehensive treatment of a rare primary malignant pericardial mesothelioma: A case report and literature review

Key Points

Study Design

PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Comprehensive treatment of a rare primary malignant pericardial mesothelioma: A case report and literature review

Key Points

Study Design

PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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