대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 514 Date 2007-09-03

  • Courtesy of Ki Nam Kim, MD, Ki- Nam Lee, MD. / Dong-A university Hospital, Korea.
  • Age/Sex 57 / F
  • Chief ComplaintExertional dyspnea for 4 months
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Desmoplastic Mesothelioma, Pericardium
Radiologic Findings
Chest radiograph shows bilateral pleural effusion with normal sized heart.
Contrast-enhanced CT scans show pericardial irrgular nodular thickening with enhancement and pericardial effusion.
Diagnosis of malignant desmoplastic mesothelioma was made after pericardiectomy.
Gross specimens are several fragments of thickened pericardium with whitish multinodular appearance.
H & E stain: Desmoplastic mesothelioma is characterized by dense collagenized tissue separated by atypical cells arraged in a storiform or patternless pattern.
Immunohistochemistry: positive for cytokeratin(epithelial marker), vimentin(spindle cell marker), D2-40 staining.
Brief Review
1) Pericaldial mesothelioma is a malignant primary neoplasm that arises from the mesothelial cells of the pericardium. The term is used to describe those tumors localized to the pericardium and does not apply to primary pleural tumors that secondarily invade the pericardium. Although pericardial mesotheliomas represent less than 1% of all malignant mesotheliomas, they account for 50% of all primary pericardial tumors.
Malignant pericardial mesothelioma encases the heart and resemble secondary involvement of the pericardium by metastatic malignancy, which is much more common. The most common malignancies that metastasize to the heart are carcinomas of the lung and breast, followed by lymphoma and leukemia.
2) Pathologic features
Malignant pericardial mesotheliomas typically form multiple coalescing pericardial masses that obliterate the pericardial space and constrict the heart. Cut sections of the masses are firm, white, and homogeneous.
3) Radiologic features
Chest radiography typically demonstrates cardiac enlargement, evidence of pericardial effusion, and irregular cardiac contour, or diffuse mediastinal enlargement. Chest CT demonstrates irregular, diffuse pericardial thickening and pericardial effusion. MR imaging also readily demonstrates cardiac encasement by a soft-tissue pericardial mass, as well as an associated pericardial effusion.
References
1. Zhen J. Wang, Gautham P. Reddy, Michael B. Gotway, Benjamin M. Yeh, Steven W. Hetts, and Charles B. Higgins. CT and MR Imaging of Pericardial Disease RadioGraphics 2003; 23: 167.
2. Mary L. Grebenc, Melissa L. Rosado de Christenson, Allen P. Burke, Curtis E. Green, and Jeffrey R. Galvin. Primary Cardiac and Pericardial Neoplasms: Radiologic-Pathologic Correlation RadioGraphics 2000 20: 1073-1103
Keywords
Pericardium, Malignant tumor,

No. of Applicants : 55

▶ Correct Answer : 21/55,  38.2%
  • - Dept. of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
  • - Dept. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
  • - CHU, Grenoble, France Anne-Line Moroni
  • - Trakya University School of Medicine, Radiology Department, Turkey Mustafa Kemal Demir
  • - Kangbuk samsung medical center, Songkyunkwan university, Korea Sun Hee Hur
  • - Sheikh khalifa hospital, Abu Dhabi, UAE Anurag Jain
  • - University of Colorado Health Sciences Center, Denver, CO, USA Seth Kligerman
  • - Soonchunhyang University Chunan Hospital, Korea Sang-Hyun Park
  • - Asan Medical Center, Korea Eun Jin Chae
  • - Annecy hospital, France Gilles Genin
  • - Ewha Womans University MokDong Hospital, Korea Yoo Kyung Kim
  • - NUH, nottingham, UK Rohit Kochhar
  • - Yongsan Hospital, College of Medicine Chung-Ang University, Korea Jae Seung Seo
  • - IRSA, La Rochelle, France Denis Chabassiere
  • - Edirne Turkey Nermin Tuncbilek
  • - ICL, Saint Etienne, France Olivier Moussatoff
  • - IRSA La Rochelle, France Jean-Luc Bigot
  • - Armidale Radiology, Australia Saurabh Khandelwal
  • - Pittwater Radiology, Australia Julie Arora
  • - China Medical University Hospital, Taiwan Jun-Jun Yeh
  • - Max Hospital, New Delhi, India Vickrant Malhotra
▶ Correct Answer as Differential Diagnosis : 16/55,  29.1%
  • - Pune, India Rahul B Deshmukh
  • - Aditya Imaging centre, Sayajigunj, Vadodara, Gujarat, India Vivek Patel
  • - Mackay Memorial Hospital, Taipei, Taiwan Chia-Fu Tsai
  • - Sao Paulo, SP Brazil Bruno Barcelos
  • - Samsung medical center, Korea Young A Bae
  • - Ruby Hall Clinic, Pune, India Nikhil Unune
  • - Yashodha Hospital, Hyderabad, India Satish Babu Maddkuri
  • - Armed Forces Chun Cheon Hospital, Korea Lim Chae Hun
  • - Saint-Etienne, France Antoine Marie
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - Kyunghee University Medical Center, Korea Su Youn Sim
  • - Ruby Hall Clinic, Pune, India John Joseph
  • - Lilavati Hospital & Rsearch Center, Mumbai, India Mahavir Swami
  • - Ultracare Coimbatore, India Debabrata Das
  • - Jackson Memorial Hospital, Miami, Florida, USA N.B.S.Mani
  • - Nassau, Bahamas Trupti Dabholkar
▶ Semi-Correct Answer : 9/55,  16.4%
  • - Kimpo Woori Hospital, Korea Son Youl Lee
  • - Registrar in Radiology, UHL NHS Trust, UK. A. Donuru
  • - E-Da hospital, Taiwan Yu-Feng Wei
  • - Osaka University, Japan Osamu Honda
  • - Sri Ravi Nursing Home, Kazipet, AP, India Pavankumar Vodithala
  • - Hospital Sotiria, Athens, Greece Vasilios Tzilas
  • - Annemasse, Polyclinique De Savoie, France Gay-Depassier Philippe
  • - CHU Grenoble, France Bing Fabrice
  • - Vital imaging centre, Mumbai, India Ganesh Agrawal
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