Pericardial Mesothelioma

Pericardial mesothelioma occurs at a much lower rate than the pleural and peritoneal varieties. According to figures compiled by the World Health Organization, only 0.3% of reported mesothelioma cases between 1994 and 2008 were pericardial1. Therefore it is extremely rare. The disease affects more men than women.

Pericardial mesothelioma affects the heart, specifically the pericardium. The pericardium is protective tissue comprised of mesothelial cells that surrounds the heart and roots of the great vessels (superior and inferior vena cava, pulmonary artery, pulmonary vein, and aorta). There are two layers: the fibrous outer (parietal) layer that serves as a shell and the inner (visceral or epicardium) layer that is right next to the heart itself. There is a small space between each layer that is filled with about 50mL of lubricating fluid. The pericardium protects the heart from friction when it moves, keeps it in place and limits motion.

How is pericardial mesothelioma caused?

Uncontrolled division of mesolethial cells in the pericardium is how pericardial mesothelioma develops. Most doctors agree that a primary cause is asbestos exposure. Asbestos can enter the body by getting inhaled or ingested, however scientists do not know exactly how it reaches the heart. Asbestos fibers may travel through the bloodstream, attaching themselves to the pericardium as blood passes through the heart.

Other possible causes include radiation exposure, tuberculosis and erionite exposure (a mineral finer that isn’t asbestos).

Pericardial mesothelioma can also be the result of mesothelioma in another area of the body (ie the lungs), and as the condition worsens tumors spread to the heart.

How do you diagnose pericardial mesothelioma?

Cases of pericardial mesothelioma are rarely diagnosed. Unlike other mesothelioma types, diagnosis is usually done after surgery or after the patient has died, during an autopsy (which is the case for 25% of current reported cases2). Thickening of the pericardium and excess fluid buildup are visual cues. A biopsy to examine cancer cells (sarcomatoid, epithelioid and biphasic) is considered the most reliable way to make an accurate diagnosis.

In addition, there is no formal staging system so this makes it difficult for doctors to design a reliable treatment plan. Once a patient has been diagnosed with pericardial mesothelioma, life expectancy is usually six months or less. However, there is a case where one patient survived for 27 months after treatment¹.

Symptoms

Symptoms of pericardial mesothelioma are often confused with those related to other medical conditions or diseases. If you do feel anything, it is mainly due to the growth of tumors pressing into or constricting the heart, or the build up of excess fluid. Symptoms include:

coughing
chest pain
weight loss
fever
fatigue
weakness
night sweats

Pericardial mesothelioma can spread to other parts of the body, including the lymph nodes, lungs and kidneys. This would cause additional symptoms.

Treatments

Treatments for pericardial mesothelioma are not standardized. Surgical removal of cancerous tissue is the most common treatment. Unfortunately, because of how close the tumors are located near the heart, surgery isn’t usually able to remove tumors completely. Chemotherapy and radiotherapy can also help decrease symptoms.

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Footnotes

1. Primary Pericardial Mesothelioma: A Rare Entity
2. Primary pericardial mesothelioma presenting as pericardial constriction: a case report

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