Moore AJ, Parker RJ, Wiggins J.

Department of Respiratory Medicine, Wexham Park Hospital, Wexham, Slough, Berkshire, UK. a.moore@ic.ac.uk

Abstract

Malignant mesothelioma is a fatal asbestos-associated malignancy originating from the lining cells (mesothelium) of the pleural and peritoneal cavities, as well as the pericardium and the tunica vaginalis. The exact prevalence is unknown but it is estimated that mesotheliomas represent less than 1% of all cancers. Its incidence is increasing, with an expected peak in the next 10-20 years. Pleural malignant mesothelioma is the most common form of mesothelioma. Typical presenting features are those of chest pain and dyspnoea. Breathlessness due to a pleural effusion without chest pain is reported in about 30% of patients. A chest wall mass, weight loss, sweating, abdominal pain and ascites (due to peritoneal involvement) are less common presentations. Mesothelioma is directly attributable to occupational asbestos exposure with a history of exposure in over 90% of cases. There is also evidence that mesothelioma may result from both para-occupational exposure and non-occupational “environmental” exposure. Idiopathic or spontaneous mesothelioma can also occur in the absence of any exposure to asbestos, with a spontaneous rate in humans of around one per million. A combination of accurate exposure history, along with examination radiology and pathology are essential to make the diagnosis. Distinguishing malignant from benign pleural disease can be challenging. The most helpful CT findings suggesting malignant pleural disease are 1) a circumferential pleural rind, 2) nodular pleural thickening, 3) pleural thickening of > 1 cm and 4) mediastinal pleural involvement. Involvement of a multidisciplinary team is recommended to ensure prompt and appropriate management, using a framework of radiotherapy, chemotherapy, surgery and symptom palliation with end of life care. Compensation issues must also be considered. Life expectancy in malignant mesothelioma is poor, with a median survival of about one year following diagnosis.

Akamoto S, Ono Y, Ota K, Suzaki N, Sasaki A, Matsuo Y, Hayashi K.

Department of Surgery, Jyuzen General Hospital, Ehime, Japan.

Abstract

Localized malignant mesothelioma in the mediastinum is rare and most known cases have been reported as “localized malignant pericardial mesothelioma.” We report a case of a middle mediastinal tumor, which we were able to resect completely. Histopathological examination of the tumor confirmed that it was a malignant epithelial lymphohistiocytoid mesothelioma. We assumed that the tumor was derived from the pericardium. Local recurrence was detected 1 year after resection, and the patient died of the disease about 2 years later.

Keywords: Localized malignant mesothelioma – Middle mediastinal tumor – Lymphohistiocytoid mesothelioma

Yamazaki M, Ohwada A, Miyaji A, Yamazaki H, Nara T, Hirai S, Fujii H, Uekusa T, Suzuki M, Iwase A, Takahashi K.

Department of Respiratory Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo. mariko@med.juntendo.ac.jp

Abstract

A 72-year-old man patient was referred to our institution for evaluation and treatment of right pleural effusion. Eosinophilic pleural effusion and peripheral eosinophilia were identified during the course of hospitalization. Pulmonary paragonimiasis was confirmed by the presence of paragonimus-specific IgG antibodies for Paragonimus (P.) westermani and P. miyazakii in his serum. Although Praziquantel, a highly effective agent for the treatment of lung flukes was repeatedly administered, the pleural effusion did not subside and the patient’s condition gradually deteriorated until his death due to circulatory insufficiency. Postmortem examination revealed malignant mesothelioma of the sarcomatous type encasing the right lung and heart. Cardiac involvement accompanied with old and recent-onset myocardial ischemic changes resulted in death of this patient. Here, we report a very rare case of malignant mesothelioma with a concomitant infection of parasitic lung fluke.

Keywords: paragonimiasis, malignant mesothelioma, eosinophilia

Menegozzo M, Izzo F, Canfora ML, Petronzio MF, Menegozzo S.

Registro Mesoteliomi della Campania, Dipartimento di Medicina Sperimentale, Seconda Università degli Studi di Napoli.

Abstract

Campania Mesothelioma Register was established in 2002; its purpose is to record every case of malignant mesothelioma that occurs in the registered population of Campania. Its aim is to identify new dangerous asbestos sources, by giving patients a questionnaire about their working and living habits. The questionnaire used is by National Mesothelioma Register (ReNaM). Analyzing carefully the answers to the questionnaire, it is possible to classify patients’ exposure with a code given by ReNaM. By means of a recognition identification network, COR Campania identified 492 cases of malignant mesothelioma (pleura, pericardium, peritoneum and tunica vaginalis of the testis) diagnosed between 1996-2007. The analysis of the ReNaM questionnaire confirms a prevalence of professional exposures (71%), however unknown exposures (15%) also play an important role. The economic sector that determined the greatest number of professional exposures are Construction (17.5%), Industrial Metalwork (13.13%), Railway Car (9.3%), Vehicle production and maintenance (8.16%), Ship building (7.5%).

Small GR, Nicolson M, Buchan K, Broadhurst P.

Department of Cardiology, University of Aberdeen, Aberdeen, Scotland AB25 2ZN, United Kingdom.

Abstract

Pericardial diseases can be difficult to differentiate from myocardial conditions. Diagnosis can be challenging and often requires the use of different imaging modalities. Here, we describe a case which presented with common cardiac symptoms which were shown to be the result of a rare condition. A 62-year-old lady presented with left femoral artery embolism. Post-embolectomy she developed cardiac failure. Three months previously an acellular, sterile pericardial effusion had been drained. In 1993 a left mastectomy and axillary node clearance was performed for breast cancer. Adjuvant chemotherapy and radiotherapy were administered. Examination revealed a raised jugular venous pressure (JVP) with rapid Y descent and Kussmaul’s sign. CT chest and abdomen found no recurrence of breast carcinoma. Cardiac MRI demonstrated thickened pericardium. At cardiac catheterisation haemodynamic responses consistent with constrictive pericarditis were seen. Pericardectomy was performed. Histology revealed pericardial epithelioid malignant mesothelioma. 18-FDG-PET CT post-operatively was negative in the pericardium and pleura. Chemotherapy with pemetrexed and carboplatin was given. The patient died 9 months after presentation. Radiotherapy and asbestos exposure are both associated with pericardial mesothelioma and the aetiology in this case was not clear. The condition carries a poor prognosis and is invariable fatal although newer chemotherapeutic regimens have prolonged survival times.

Keywords: Pericardium; Mesothelioma; Radiotherapy

Santos C, Montesinos J, Castañer E, Sole JM, Baga R.

Hospital de Sabadell, Corporació Parc Taulí, Institut Universitari, Sabadell-Barcelona, Spain.

Abstract

Primary pericardial mesothelioma is a rare clinical entity; about 150 cases have been described in literature. It is a highly aggressive tumour with global survival under 6 months. We present a 44-year-old man with a primary pericardial mesothelioma who received treatment under clinical essay with carboplatinum and pemetrexed reaching tumoral response; consolidation radiotherapy was administered. Ten months after end of radiotherapy, tumoral progression was detected, and patient received second line of chemotherapy. The patient died 16 months after diagnosis. New cytotoxic drugs can improve the prognosis of this rare entity.

Hillerdal G, Elmberger G.

Department of Lung Medicine, Karolinska University Hospital, Stockholm, Sweden. gunnar.hillerdal@karolinska.se

Abstract

Mesothelioma can occur in different variants, some of which are difficult or impossible to differentiate from sarcomas. There are scattered reports of sarcomatous mesotheliomas that have osteogenic properties. Here, we report a 57-year old man who presented with a mediastinal tumor containing scattered irregular calcifications with some scattered pleural thickening of the right pleura. Biopsy showed a sarcoma with bone formation. The man was born in the Turkish village of Karain, where the incidence of mesothelioma is extremely high, and a sarcomatous mesothelioma was therefore diagnosed. Since the tumor was pressing against the large vessels and heart, a debulking was performed, followed by Pemetrexed and Carboplatin treatment. However, the tumor grew rapidly and spread to the pleura, involved the heart, and the patient succumbed. This is to our knowledge the first report of a sarcomatous mesothelioma with bone formation from environmental exposure to mineral fibers.

Doval DC, Pande SB, Sharma JB, Rao SA, Prakash N, Vaid AK.

Department of Medical Oncology, Rajiv Gandhi Cancer Institute, New Delhi, India. dcdoval@yahoo.com

Abstract

Pericardial mesothelioma remains a disease with a bleak prognosis. We report the case of a patient with metastases to liver and good response to pemetrexed and carboplatin-based combination chemotherapy and consequent prolonged progression-free survival.

Tao Jin, MD, Hai-Yong Wang, MD¹, Yi-Ming Ni, MD

Department of Cardiothoracic Surgery
¹ Department of Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

For reprint information contact: Yiming Ni, MD Tel/fax: 86 571 8723 6645 Email: Ni_yiming@hotmail.com, Department of Cardiothoracic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang 310003, China.

Abstract

We report a case of intracardiac mesothelioma complicated by chronic disseminated intravascular coagulopathy in a 50-year-old woman. Her symptoms were completely relieved by emergency resection of the tumor. Primary resection of the intracardiac mesothelioma is adequate treatment for this complicated surgical problem.

Senkottaiyan N, Seacord LM, Fulling KH, Birchem JA, Fraley MA, Alpert MA.

Department of Medicine and Pathology, St. John’s Mercy Medical Center, St. Louis, MO 63141, USA.

Abstract

A 71-year-old man, a cigarette smoker with long-term asbestos exposure, developed multifocal malignant sarcomatous pleural mesothelioma that metastasized to the left ventricular endocardium without invading pericardium, myocardium, or the contiguous pulmonary vein. This is the first reported case of malignant pleural mesothelioma to metastasize in such a manner.