Schwartzenberg Shmuel, Shapira Yaron, Rubachevski Victor, Sharony Ram
The Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St., Petah Tikva 4941492, Israel.
Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Eur Heart J Case Rep. 2023 Feb 24;7(3):ytad100. doi: 10.1093/ehjcr/ytad100. eCollection 2023 Mar.
Primary pericardial mesothelioma is an extremely rare disease. Prognosis is poor, with little effects of chemo- or radio-therapy. The majority of cases is diagnosed at autopsy.
A 22-year-old man, who presented with recurrent pericarditis and large pericardial effusion 2 months after a second BNT162b2 COVID-19 vaccine, underwent pericardiocentesis and pericardial window. Pathology specimen of pericardium revealed benign mesothelial inflammation, consistent with acute pericarditis. Four months later, he presented with a large pericardial mass manifesting in heart failure and underwent urgent pericardiectomy. A new pathology specimen immunostaining and fluorescence hybridization analysis revealed pericardial mesothelioma. Despite intensive care, the patient died 3 weeks later.
Primary pericardial mesothelial should be considered in the differential diagnosis of refractory recurrent pericarditis, even with prior biopsy-proven pericarditis or when a putative trigger (COVID-19 mRNA prior vaccination) is suspected, as was the case in this patient. Tumour diagnosis and identification consist of multimodal imaging and laboratory tests. A multidisciplinary, individualized care approach should be performed.
原发性心包间皮瘤是一种极为罕见的疾病。预后较差，放化疗效果甚微。大多数病例在尸检时才得以确诊。
一名22岁男性，在接种第二剂BNT162b2新冠疫苗2个月后出现复发性心包炎和大量心包积液，接受了心包穿刺术和心包开窗术。心包病理标本显示为良性间皮炎症，符合急性心包炎。四个月后，他出现一个导致心力衰竭的大型心包肿物，并接受了紧急心包切除术。新的病理标本免疫染色和荧光杂交分析显示为心包间皮瘤。尽管进行了重症监护，患者仍在3周后死亡。
即使之前活检证实为心包炎，或怀疑有假定诱因（新冠mRNA疫苗接种前），如本病例，在难治性复发性心包炎的鉴别诊断中也应考虑原发性心包间皮瘤。肿瘤的诊断和鉴别包括多模态影像学检查和实验室检查。应采取多学科、个体化的治疗方法。
