Primary Pericardial Mesothelioma: Report of a Patient and Literature Review.
Primary Pericardial Mesothelioma: Report of a Patient and Literature Review.
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原发性心包间皮瘤：患者报告和文献综述。
DOI：
10.1159/000228894
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发表时间：
2009-07-29
影响因子：
0.8
通讯作者：
Rasmuson, Torgny
中科院分区：
文献类型：
--
作者：
Nilsson, Ase;Rasmuson, Torgny
原发性心包间皮瘤是一种罕见的肿瘤，预后不佳。本病例报告提出一位38岁男性，因反复出现心包积液。最初症状不明确，有干咳和进行性疲劳。行心包穿刺，但恶性细胞和结核分析呈阴性。复发后计划行心包切除术。手术时，切除心脏周围部分肿瘤组织。组织病理学检查包括免疫组化calretinin染色显示为双期间皮瘤。术后患者病情有所改善，但症状复发，患者在确诊后3个月和首次出现症状后15个月死亡。尸检时，心包被肿瘤转化，肿瘤也扩展到纵隔，并转移到肝脏。对最近文献中29例病例的回顾表明，男性恶性心包间皮瘤的发病率高于女性。中位年龄46岁（范围19-76岁）。在胸膜间皮瘤中，暴露于石棉是一个已知的危险因素。然而，在原发性心包间皮瘤中，石棉作为病因的证据似乎不太令人信服（14例中有3例暴露）。症状通常不明确，心包液细胞学检查很少有结论性（4/17例显示恶性细胞）。部分切除肿瘤可使症状减轻一段时间。只有少数病人接受了化疗。心包间皮瘤患者的中位生存期约为6个月。
Primary mesothelioma of the pericardium is a rare tumor and carries a dismal prognosis. This case report presents a 38-year-old man who suffered from recurrent pericardial fluid. Initial symptoms were unspecific, with dry cough and progressing fatigue. Pericardiocentesis was performed, but analyses for malignant cells and tuberculosis were negative. After recurrence a pericardiectomy was planned. At operation, partial resection of tumor tissue surrounding the heart was performed. Histopathologic examination including immunohistochemical staining for calretinin showed a biphasic mesothelioma. During the postoperative period the patient's condition ameliorated, but symptoms recurred and the patient died 3 months after diagnosis and 15 months after the first symptoms. At autopsy, the pericardium was transformed by the tumor that also expanded into the mediastinum and had set metastases to the liver. A review of 29 cases presented in the recent literature indicates a higher incidence of malignant pericardial mesothelioma among men than women. Median age was 46 (range, 19–76) years. In pleural mesotheliomas, exposure to asbestos is a known risk factor. However, in primary pericardial mesotheliomas the evidence for asbestos as an etiologic factor seems to be less convincing (3 exposed among 14 cases). Symptoms are often unspecific and cytologic examination of pericardial fluid is seldom conclusive (malignant cells demonstrated in 4/17 cases). Partial resection of the tumor can give a period of symptom reduction. Only a few patients have been treated with chemotherapy. Median survival of patients with pericardial mesotheliomas is approximately 6 months.