Intracavitary Mass as the Initial Manifestation of Primary Pericardial Mesothelioma

Abstract

A 31-year-old woman presented with a 3-month history of progressing fatigue and effort dyspnea. Echocardiography depicted a tumor within the free wall of the right ventricle and right atrium, located on both sides of the tricuspid annulus. Computed tomography showed disseminated circular shadows sized up to 7 mm—most likely metastatic lesions—in both lungs. The diagnosis of low-grade mesothelioma bifasicum was confirmed with histopathologic and immunohistochemical studies of the samples taken by thoracoscopy from parietal pleura, lung tumor, and diaphragm region. Chemotherapy, which included gemcitabine and carboplatin, resulted in transient improvement of the clinical status of the patient and reduction of the tumor mass lasting several months followed by progression of the disease. Significant amounts of pleural fluid and huge tumors within both pleural cavities emerged. The patient died due to respiratory and circulatory insufficiency 11 months following the diagnosis.