ECTS 2012 - localized isolated intrapericardial mesotheliomaLOCALIZED ISOLATED INTRAPERICARDIALMESOTHELIOMAMohammed Alaa N...
Case report   49 years old female   presented by shortness of breath   chest pain which was retrosternal and stitching ...
Investigations   Chest x-ray    ECTS 2012 - localized isolated intrapericardial mesothelioma   March
Investigations   Echocardiography : revealed moderate to    severe pericardial effusion , a mass was seen    related to t...
Investigations   Pericardiocentesis revealed reddish fluid   Pathological examination: occasional small    sized balls o...
Investigations   Chest CT    ECTS 2012 - localized isolated intrapericardial mesothelioma   March
Investigations   Preoperative CT guided biopsy from the mass   Pathological examination: core of tissue showing    solid...
Neoadjuvent chemotherapy   Patient received 2 cycles chemotherapy with    VP-16 (Etoposide) and platinol (cisplatin) then...
Operative finding   left anterolateral thoracotomy was performed    ECTS 2012 - localized isolated intrapericardial mesot...
Operative finding ECTS 2012 - localized isolated intrapericardial mesothelioma   March
Histopathology   Microscopic examination: irregular sheets of    monotonous small rounded cells arranged    around      s...
Immunochemistry   the tumor cells were immuno-reactive with CK    (epithelial tissue marker )   non reactive with either...
Post operative chemotherapy   Patient received 3 cycles of chemotherapy    with Gemcitabine (Gemzar) and platinol    (cis...
Outcome   The patient was followed up by chest CT and    echocardiography for 11 month                                  p...
pericardial mesothelioma   There are several cancers and diseases that    affect the pericardial space around the heart ...
pericardial mesothelioma   Pericardial mesothelioma presents either as a    localized tumor associated with pericardial  ...
comments   A review of the literature yielded five cases of    localized pericardial mesothelioma, including    the prese...
ECTS 2012 - localized isolated intrapericardial mesothelioma        Questions           ?             THANK YOUMarch    Hu...
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Localized isolated intrapericardial mesothelioma

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Localized isolated intrapericardial mesothelioma

  1. 1. ECTS 2012 - localized isolated intrapericardial mesotheliomaLOCALIZED ISOLATED INTRAPERICARDIALMESOTHELIOMAMohammed Alaa Nady, Hussein Elkhayat, Mohammed Mahmoud Mostafa and MagedAbdelfattah . Hussein Elkhayat Cardiothoracic Surgery Department Faculty of Medicine-Assiut university Assiut – Egypt March
  2. 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. 3. Investigations Chest x-ray ECTS 2012 - localized isolated intrapericardial mesothelioma March
  4. 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. 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. 6. Investigations Chest CT ECTS 2012 - localized isolated intrapericardial mesothelioma March
  7. 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. 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. 9. Operative finding left anterolateral thoracotomy was performed ECTS 2012 - localized isolated intrapericardial mesothelioma March
  10. 10. Operative finding ECTS 2012 - localized isolated intrapericardial mesothelioma March
  11. 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. 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. 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. 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. 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. 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. 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. 18. ECTS 2012 - localized isolated intrapericardial mesothelioma Questions ? THANK YOUMarch Hussein Elkhayat : dr_khayat@hotmail.com

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