1. ECTS 2012 - localized isolated intrapericardial mesothelioma
LOCALIZED ISOLATED INTRAPERICARDIAL
MESOTHELIOMA
Mohammed Alaa Nady, Hussein Elkhayat, Mohammed Mahmoud Mostafa and Maged
Abdelfattah .
Hussein Elkhayat
Cardiothoracic Surgery Department
Faculty of Medicine-Assiut university
Assiut – Egypt
March

2. Case report
 49 years old female
 presented by shortness of breath
 chest pain which was retrosternal and stitching
in character.
 On examination: the patient was orthopneic ,
 congested neck veins
 distant cardiac sounds
 mild lower limb edema (ankle edema ) .
ECTS 2012 - localized isolated intrapericardial mesothelioma March

3. Investigations
 Chest x-ray
ECTS 2012 - localized isolated intrapericardial mesothelioma March

4. Investigations
 Echocardiography : revealed moderate to
severe pericardial effusion , a mass was seen
related to the left atrium , the parietal
pericardium was thickened and The cardiac
dimensions were normal
ECTS 2012 - localized isolated intrapericardial mesothelioma March

5. Investigations
 Pericardiocentesis revealed reddish fluid
 Pathological examination: occasional small
sized balls of atypical epithelial/mesothelial
cells scattered in hemorrhagic background
 suggestive of malignancy.
ECTS 2012 - localized isolated intrapericardial mesothelioma March

6. Investigations
 Chest CT
ECTS 2012 - localized isolated intrapericardial mesothelioma March

7. Investigations
 Preoperative CT guided biopsy from the mass
 Pathological examination: core of tissue showing
solid sheets of malignant epithelial cells
surrounded by markedly hyalinosed fibrous tissue
 suggestive of poorly differentiated carcinoma with
immunophenotyping negative for CK7 ,CK20 and
positive for pan CK
ECTS 2012 - localized isolated intrapericardial mesothelioma March

8. Neoadjuvent chemotherapy
 Patient received 2 cycles chemotherapy with
VP-16 (Etoposide) and platinol (cisplatin) then
scheduled for surgery after 3 weeks.
ECTS 2012 - localized isolated intrapericardial mesothelioma March

9. Operative finding
 left anterolateral thoracotomy was performed
ECTS 2012 - localized isolated intrapericardial mesothelioma March

10. Operative finding
ECTS 2012 - localized isolated intrapericardial mesothelioma March

11. Histopathology
 Microscopic examination: irregular sheets of
monotonous small rounded cells arranged
around small vascular slits in
hemangiopericytoma like pattern
 tumor cells have scanty cytoplasm , relatively
large hyperchromatic nuclei with coarse
chromatin and inconspicuous nuclei
 the investing stroma was abundant
hemorrhagic and desmoplastic in nature.
ECTS 2012 - localized isolated intrapericardial mesothelioma March

12. Immunochemistry
 the tumor cells were immuno-reactive with CK
(epithelial tissue marker )
 non reactive with either NSE,CD34,TTF1,CK7
or CK20 .
 Calretinin, WT-1, D2-40, mesotelin,
thrombomodulin and CK5/CK6 are not
available in our institute.
 The diagnosis was a small cell variant of
malignant mesothelioma .
ECTS 2012 - localized isolated intrapericardial mesothelioma March

13. Post operative chemotherapy
 Patient received 3 cycles of chemotherapy
with Gemcitabine (Gemzar) and platinol
(cisplatin).
 followed by another 3 cycles of the same
regimen for a total of 11 months.
ECTS 2012 - localized isolated intrapericardial mesothelioma March

14. Outcome
 The patient was followed up by chest CT and
echocardiography for 11 month postoperatively
during which stationary course of the disease
were reported and no recurrence was detected.
 She reports that she lives a normal life after 2.5
years from time of the operation.(sept.2009-
present)
ECTS 2012 - localized isolated intrapericardial mesothelioma March

15. pericardial mesothelioma
 There are several cancers and diseases that
affect the pericardial space around the heart
 pericardial mesothelioma is one of the rarest.
However, it is the most common primary
malignant pericardial tumor.
 It can also be secondary to malignant pleural
mesothelioma.
ECTS 2012 - localized isolated intrapericardial mesothelioma March

16. pericardial mesothelioma
 Pericardial mesothelioma presents either as a
localized tumor associated with pericardial
effusions or as an encasing mass involving the
whole pericardium.
 The degree of invasion varies; local infiltration
into the cardiac chambers is reported
ECTS 2012 - localized isolated intrapericardial mesothelioma March

17. comments
 A review of the literature yielded five cases of
localized pericardial mesothelioma, including
the present. Most cases are seen in women
and are of the epithelial variant.
ECTS 2012 - localized isolated intrapericardial mesothelioma March

18. ECTS 2012 - localized isolated intrapericardial mesothelioma
Questions
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THANK YOU
March Hussein Elkhayat : dr_khayat@hotmail.com