Pericardial mesothelioma is much less common than malignant mesothelioma of the pleura or peritoneum. In fact there are only about 150 cases ever reported in the medical literature. It affects the section of the mesothelium called the pericardium (the mesothelial lining of the heart). People in the fourth to seventh decades of life are most likely to have this cancer, and there is a 2:1 male to female ratio. Currently, surgical excision (removal) of the pericardium is the treatment for pericardial mesothelioma, primarily to lessen symptoms of constriction around the heart.
Symptoms that are associated with pericardial mesothelioma include:
- Chest pain
- Fluid buildup around the heart
- A mass in the space between the lungs
- Abnormal or difficult breathing (dyspnea)
- Chronic coughing
- Irregular heartbeat (palpitations)
A recent review of the primary pericardial mesothelioma has been published by Vigneswaran and Stefanacci. It is a rare neoplasm with a reported incidence of 0.0022% in an autopsy series of 5,000,000 case studies 212 and a calculated annual incidence of 1 in 40 million in a Canadian epidemiologic survey. An antemortem diagnosis was made in less than one-third of 150 reported cases in the literature. Pericardial mesotheliomas can occur at any age, but people in the fourth to seventh decades of life are most likely to be afflicted, and there is a 2:1 male to female ratio. Patients generally present with a pericardial effusion, congestive heart failure, an anterior mediastinal mass, or tamponade. Diagnosis can be difficult given the nonspecific presentation, and chest radiography may demonstrate only an enlarged cardiac silhouette. Echocardiography can reveal evidence of an effusion, thickening of the pericardium, or mass involvement of the myocardium. CT scanning or MRI can show a thickened pericardium and may help determine invasion into myocardium.
Currently, surgical excision is the treatment for primary pericardial mesothelioma primarily to palliate symptoms of constriction or tamponade.
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