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Malignant pericardial mesothelioma

A systematic review of current practice

Malignes Perikardmesotheliom

Systematische Übersicht über das aktuelle Vorgehen

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Abstract

Background

Malignant mesothelioma is a rare but aggressive tumor, with a high misdiagnosis rate and overall bleak prognosis. In 0.7% of all cases, the origin is the pericardium.

Methods

The present study is a review of the literature published in recent decades focusing on the advances in clinical manifestations, radiological findings, diagnosis, differential diagnosis, and treatment of malignant pericardial mesothelioma (MPM).

Results

No clear relationship has been established between the etiologies and the development of MPM. Clinical symptoms and signs are nonspecific when present. The main presentations are chest pain and dyspnea. Imaging plays an important role in the detection, characterization, staging, and posttreatment follow-up. The definitive diagnosis is made on the basis of pathological findings. Chest radiography and echocardiography are common techniques used initially, but their roles are limited. Computed tomography and magnetic resonance imaging have an advantage in depicting the thickened pericardium, mediastinal lymph node, tumor, and the extension of adjacent structures. Surgery is the most important treatment modality and remains palliative in most cases, while the roles of chemo- and radiotherapy are unsatisfactory.

Conclusion

Clinical trials of malignant pleural and peritoneal mesothelioma remain important for MPM management. Multimodality treatment of surgery, chemotherapy, radiotherapy, and immunotherapy is expected to have a role in the treatment of MPM.

Zusammenfassung

Hintergrund

Ein malignes Mesotheliom ist ein seltener, aber aggressiver Tumor mit einer hohen Rate an Fehldiagnosen und allgemein ungünstiger Prognose. Insgesamt 0,7 % aller Fälle haben ihren Ursprung im Perikard.

Methoden

Die vorliegende Arbeit gibt eine Übersicht über die Literatur, die in den letzten Jahrzehnten mit Fokus auf die Fortschritte in der Erhebung der klinischen Symptomatik, Röntgenbefunde, Diagnose, Differenzialdiagnose und Behandlung des malignen Perikardmesothelioms (MPM) veröffentlicht wurde.

Ergebnisse

Es wurde keine klare Beziehung zwischen den Krankheitsursachen und der Entwicklung des MPM hergestellt. Klinische Symptome sind, wenn vorhanden, unspezifisch. Die wichtigsten Symptome sind Schmerzen in der Brust und Atemnot. Die bildgebende Diagnostik spielt eine wichtige Rolle bei Erkennung, Charakterisierung, Staging und Nachsorge nach der Behandlung. Die definitive Diagnose wird auf der Grundlage pathologischer Befunde gestellt. Die Thoraxröntgenuntersuchung und Echokardiographie sind gängige, zunächst eingesetzte diagnostische Maßnahmen, aber ihre Bedeutung ist begrenzt. CT und MRT sind zur Darstellung eines verdickten Perikards, der mediastinalen Lymphknoten, des Tumors und der Ausdehnung auf benachbarte Strukturen vorteilhaft. Chirurgische Eingriffe stellen die wichtigste Modalität dar und bleiben in den meisten Fällen eine palliative Maßnahme, die Rolle der Chemo- und Strahlentherapie ist ebenfalls unbefriedigend.

Schlussfolgerung

Die klinischen Studien des MPM bleiben für die Versorgung des MPM wichtig. Die multimodale Behandlung mit Chirurgie, Chemo-, Radio- und Immuntherapie ist vermutlich bei der Behandlung des MPM von Bedeutung.

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Acknowledgements

This work was supported by the National Natural Scientific Foundation of China (No: 81572824, 81673007 and 81672931), Health Department of Heilongjiang Provincial of China (No: 2011-124), Harbin Medical University Cancer Hospital major project Foundation (No: JJZ-2010-01), Provincial Department of Education (No: 12521284).

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Correspondence to Y. Yu.

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Shoubo Cao, Shi Jin, Jingyan Cao, Jing Shen, Hua Zhang, Qingwei Meng, B. Pan, and Y. Yu declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Cao, S., Jin, S., Cao, J. et al. Malignant pericardial mesothelioma. Herz 43, 61–68 (2018). https://doi.org/10.1007/s00059-016-4522-5

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