:Malignant mesothelioma, biphasic

Histochemical and  immunohistochemical studies;

    Calretinin ; +,      CK5/6 ; -,      CEA ; -,      D-PAS ; -

  

Primary Pericardial Mesothelioma

Malignant primary neoplasm that arises from the mesothelial cells of the pericardium
represent less than 1% of all malignant mesotheliomas
One of the largest autopsy series gives an incidence of 0.0022% in 500000 cases
50% of all primary pericardial tumors

Clinical Features

male-to-female ratio = 2 : 1
Mean age : 46 years (age range, 2-78 years)
 

Clinical symptoms

chest pain, cough, dyspnea, palpitations

diffuse pericardial involvement

mimic pericarditis or cardiac tamponade

Asbestos exposures (?)

14% of primary pericardial mesothelioma
Prognosis; extremely poor

with a survivals of 6 months to 1 year after diagnosis

Pathologic features

Gross Finding

Diffuse growth (18/25, 72%)

Myocardial invasion (18/28, 64%)

Extra-mediastinal metastases (7/28, 25%)

Localized or solitary mass

4 reported cases in English literature

Histopathologic finding

Biphasic (35%), Epithelioid (35%), Sarcomatoid (30%)

Imaging features

Chest X-ray

   normal

   cardiac enlargement (m/c)

   irregular cardiac contour, diffuse mediastinal enlargement

   Echocardiography

   Pericardial effusion (m/c)

   Thickened pericardium

   Pericardial mass

   Valve abnormality

CT

   Diffuse tumor that encases heart

   Irregular, diffuse pericardial thickening  

   pericardial effusion

   Pericardial mass

   extremely rare (Several reported cases)  

MRI

   TIWI: iso or slightly higher signal intensity than myocardium

   T2WI: iso or higher signal intensity than fat

   Gd-enhanced MRI: heterogenous enhanced signal intensity

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