[Primary malignant mesothelioma of the pericardium masquerading as malignant pleural mesothelioma: report of an autopsy case and review of the reported cases in Japan as to its invasion to neighboring organs].
The Patient was a 72-year-old man who presented with dyspnea and general fatigue. Chest X-ray and CT-scan at the admission showed bilateral pleural effusion with collapse of the left lung and pericardial effusion. Cytology from the left pleural effusion suggested malignant mesothelioma. For this reason, malignant mesothelioma of the left pleura was diagnosed clinically and it was supposed to have spread subsequently to the pericardium. At autopsy, entire surface of the heart was found to be encroached in a diffuse fashion by a thick layer of mesothelioma tissues, which formed a small mass around the left pulmonary vein over the left atrium and invaded deep into the myocardium of all cardiac chambers. The endocardium and the intima of the left pulmonary vein were free of the invasion. The parietal pericardium adhered in places to the cardiac lesion, but no direct invasion to the adjacent pleurae through the pericardial wall was present. The left pleura over the lung and chest cavity disclosed only a superficial invasion by similar mesothelioma which was identifiable only on microscopic study. No distant metastasis was present in any thoracic and other organs as well as lymph nodes including the hilar ones of the lung. It seemed most likely from this anatomical finding that the primary site of the present mesothelioma was in the pericardium (visceral) and the tumor spread to the left pleura by a continuous extension along the outside of the left pulmonary vein. Primary malignant mesothelioma of the pericardium is of very rare occurrence and we found only 51 cases of it in the Japanese literature since 1915.(ABSTRACT TRUNCATED AT 250 WORDS)
Torii
T
T
Takasuga
H
H
Mizushima
M
M
Ito
J
J
Kanaya
T
T
Matsushima
T
T
D000368:Aged; D003581:Cytodiagnosis; D003937:Diagnosis, Differential; D006338:Heart Neoplasms / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis* / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D010496:Pericardium; D010997:Pleural Neoplasms / Q000175:diagnosis / Q000473:pathology; D014057:Tomography, X-Ray Computed