Post-irradiation pericardial malignant mesothelioma: an autopsy case and review of the literature

We report a case of a malignant pericardial mesothelioma of the epithelioid type in a 39-year-old man. He had a history of nodular sclerosing Hodgkinʹs disease treated with irradiation of the cervical and mediastinal regions 24 years before, and of infarction of the anterior wall of the left ventricle, after which a percutaneous coronary intervention was carried out 7 years previously. He was admitted to a cardiology unit with progressive dyspnea. On examination, a hemorrhagic pericardial fluid collection of 600 ml was detected which was successfully drained. On the next day, the patient developed an electromechanical dissociation suggesting a pericardial tamponade, which was followed by circulatory arrest. At autopsy, the pericardial sac was found to contain 300 ml of partly clotted blood. The epicardial surface showed a diffuse thickening, suggesting a chronic fibrous pericarditis without a macroscopically evident distinct tumor mass. A rupture measuring 0.4 cm in diameter was detected in the right ventricular free wall, 1 cm below the level of the tricuspid valve. The diagnosis of a diffusely growing, malignant mesothelioma of the epithelioid type was made on the basis of histological and immunohistochemical examination of the thickened pericardium.