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Weekly Chest CasesImaging Conference Cases

Case No : 8

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  • Age/Sex 55 / F
  • Case Title Dyspnea and chest pain for 7 days
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Diagnosis With Brief Discussion

Courtesy
Youngdong Severence Hospital, Yonsei University
Imaging Findings
Pathologic Diagnosis
[Thoracotomy mass excision]

:Malignant mesothelioma, biphasic



Histochemical and immunohistochemical studies;

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

Discussion
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
Reference
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
Keywords
Pleura, Malignant tumor, Malignant Mesothelioma, Biphasic
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