Diagnostic challenges of pericardial mesothelioma: A case report and review of literature

Abstract Background Primary pericardial malignant mesothelioma (PPMM) is a rare malignancy arising from the serous mesothelial lining of the pericardium. These neoplasms are aggressive in nature, pose diagnostic difficulties, have a poor prognosis, and have a median survival of fewer than six months. Case presentation The first case involves a 75-year-old woman who presented with progressively worsening dyspnoea, unintentional weight loss, intermittent fevers, and chest pain. A chest computed tomography (CT) scan revealed thickened pericardium and two large pericardial masses anterior to the right ventricle. The second case involves a 77-year-old man who presented with progressively worsening dyspnoea, fatigue, and decreased exercise tolerance. A chest CT scan revealed an irregular soft tissue mass posterior to the left atrium with bilateral pleural effusions and an absence of mediastinal lymphadenopathy. Histopathological analysis of both cases revealed malignant pericardial mesothelioma with homozygous deletion of CDKN2A. Due to extensive disease, both patients were referred to medical oncology for palliative chemotherapy. Both patients died two months following receiving a formal diagnosis of PPMM. Conclusion PPMM remains a rare and poorly understood malignancy of undetermined aetiology. We describe two cases of PPMM and provide an update and guidance on the contemporaneous management of this challenging condition.