Hirnle Grzegorz, Kapałka Michał, Krawiec Michał, Hrapkowicz Tomasz
Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland.
Student Scientific Association of Adult Cardiac Surgery, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Katowice, Poland.
Front Oncol. 2025 Jan 17;14:1481373. doi: 10.3389/fonc.2024.1481373. eCollection 2024.
Pericardial mesothelioma is an exceedingly rare pericardial neoplasm. It has atypical clinical symptoms and imaging characteristics that often lead to an inconclusive diagnosis. The diagnosis of a rare tumor such as pericardial mesothelioma, which can present with a variety of manifestations, requires a multidisciplinary approach.
A 36-year-old Caucasian female patient without significant past medical history was admitted to the hospital with chest pain and a high fever and was diagnosed with acute pericarditis. The following month, the patient was treated for sepsis; during this hospitalization, lab tests for antinuclear antibodies (ANA) turned out to be positive. Concurrently, mediastinal lymphadenopathy was observed. Given the suspicion of mediastinal lymphoma, a mediastinoscopy with lymph node biopsy was performed. Following a negative biopsy result, positron emission tomography combined with computed tomography (PET/CT) and blood immunophenotyping were performed. Both tests ruled out a diagnosis of lymphoma. Concurrently, the patient was hospitalized in the rheumatology department due to positive ANA results. There, in addition to the ANA titer at a level of 1:320, lupus anticoagulant was detected. The patient was diagnosed with systemic lupus erythematosus (SLE) and initiated on chronic steroid therapy. As heart failure progressed, the patient was admitted to the cardiology department. Tissue Doppler echocardiography and cardiac magnetic resonance imaging (MRI) revealed features indicative of constrictive pericarditis. The patient underwent a pericardiectomy with satisfactory results. However, the pathology result of the pericardium remained equivocal. The patient was readmitted 3 months later with severe circulatory failure, and a salvage procedure of pericardiectomy was performed. Histopathological examination of the sections confirmed the diagnosis of pericardial epithelioid mesothelioma. The patient died after 3 weeks of palliative care.
In the differential diagnosis of relapsing and resultant constrictive pericarditis, neoplastic processes that may mimic systemic rheumatic diseases should also be considered. Pericardial mesothelioma is a very rare diagnosis and may result in increased ANA titers, particularly anti-dense fine speckled 70 (DFS70) antibodies.
心包间皮瘤是一种极其罕见的心包肿瘤。它具有非典型的临床症状和影像学特征，常导致诊断不明确。对于像心包间皮瘤这样可表现出多种症状的罕见肿瘤，其诊断需要多学科方法。
一名36岁无重大既往病史的白人女性患者因胸痛和高热入院，被诊断为急性心包炎。次月，该患者接受败血症治疗；在此住院期间，抗核抗体（ANA）实验室检查结果呈阳性。同时，观察到纵隔淋巴结肿大。鉴于怀疑纵隔淋巴瘤，进行了纵隔镜检查及淋巴结活检。活检结果为阴性后，进行了正电子发射断层扫描结合计算机断层扫描（PET/CT）和血液免疫表型分析。两项检查均排除了淋巴瘤诊断。同时，由于ANA结果呈阳性，患者入住风湿科。在那里，除了ANA滴度为1:320外，还检测到狼疮抗凝物。该患者被诊断为系统性红斑狼疮（SLE）并开始接受慢性类固醇治疗。随着心力衰竭进展，患者入住心内科。组织多普勒超声心动图和心脏磁共振成像（MRI）显示有缩窄性心包炎的特征。患者接受了心包切除术，效果满意。然而，心包的病理结果仍不明确。3个月后患者因严重循环衰竭再次入院，并进行了心包切除术挽救手术。切片的组织病理学检查确诊为心包上皮样间皮瘤。患者在姑息治疗3周后死亡。
在复发性和继发性缩窄性心包炎的鉴别诊断中，也应考虑可能模拟系统性风湿性疾病的肿瘤性病变。心包间皮瘤是一种非常罕见的诊断，可能导致ANA滴度升高，尤其是抗致密细斑点70（DFS70）抗体。
