Mesothelioma - a rare tumor of the mesothelium cells lining the serous membranes - the pleura, pericardium and peritoneum. Accordingly, distinguish mesothelium th data locations, including mesothelioma is extremely rare pericardium. First pericardial mesothelioma has been described by Foster in 1893, is currently in the literature collected a little more than 200 observations, and only in rare cases, the disease was diagnosed in vivo. Clinical diagnosis of mesothelioma, in particular, mesothelioma of the pericardium, is difficult due to the absence of any specific symptoms of early tumors. In most patients, the first manifestations of the disease appear within 2-3 months prior to the detection of tumors and are characterized by the accumulation of serous-hemorrhagic fluid in the pericardium, which is regarded as serous-hemorrhagic pericarditis. At the same time, the presence of mesothelioma accumulation of fluid in the serous cavities is recurrent in nature, as evidenced by repeated puncture. Timely clinical diagnosis of tumors allows for radical surgery - perikardektomiyu or perform palliative intervention that prevents the accumulation of fluid.
Morphological diagnosis of mesothelioma also presents certain difficulties due to the many faces of the tumor morphological variants. Distinguish benign, fibrous mesothelioma and malignant variant variant of the tumor, in which she, like carapace that envelops the heart, has invasive growth and metastasizing. Histologically, the most common form is an epithelioid variant, are difficult to distinguish from adenocarcinoma we scirrhous, solid cancers. A rare form of mesothelioma is a sarcomatous variant similar to angioendoteliomu, polymorphocellular sarcoma. Possible, and a mixed variant of the tumor - cancer-sarcomatous. All histological types of malignant mesothelioma, even when expressed cellular polymorphism characterized by an extremely rare mitosis [2]. Meta staziruet lymphogenous mesothelioma, hematogenous metastases to her are not typical.
Provides surveillance of malignant mesothelioma of the pericardium diagnosed at autopsy.
Patient 64 years old, moved to Belarus from Kazakhstan and sought medical attention with complaints of pain in the chest, right hand on weight loss
17 kg in six months, alopecia, and increased blood pressure. Considers himself sick for six months, but medical help was not appealing and do not undergo any examination for 7 years.
After inspection, the patient made a general and biochemical blood tests, which marked leukocytosis - 21.7 x 10 12 , increasing urea (343 mmol / l) and creatinine (486 mmol / L), the patient was hospitalized in satisfactory condition and are diagnosed with Cancer right easy? Chronic lymphocytic leukemia? Lymphosarcoma? Chronic pyelonephritis, secondary hypertension. Chronic ischemic heart disease, diffuse cardio.
On the second day of hospitalization the patient's condition deteriorated, the woman complained of severe weakness, chills, shortness of breath, and was transferred to the intensive care unit where cardiac arrest occurred, and although, on resuscitation, death occurred final clinical diagnosis: 1 . Acute deep vein thrombophlebitis of the right leg. Recurrent thromboembolism small pulmonary artery branches. 2. Chronic pyelonephritis. Secondary hypertension. Possible violation of cerebral circulation. Uremia. Erosive gastritis. Complications: gastric bleeding, chronic renal failure III. Concomitant diseases: chronic ischemic heart disease: myocardial infarction (ECG). Aortic atherosclerosis, coronary arteries. H 11A. Chronic bronchitis, emphysema, diffuse pulmonary fibrosis. Chronic pulmonary heart. NAM II-III. Diabetes mellitus, first identified.
At autopsy marked edema of the subcutaneous tissue on the right leg and foot in the deep veins of the legs - red clots. Light in the pleural cavities are free, pleura smooth and shiny. In the lungs - congestion, edema, a small ramifications of the pulmonary artery - thromboembolism. In the pericardial cavity of about 80 ml of hemorrhagic fluid, visceral piece of thickened, covered with the multitude of gray nodules 2-3 mm in diameter, merging together. Heart 420 g, thickness of the left ventricle muscle - 1.5 cm, right - 0.5 cm irregularly narrowed heart artery atherosclerotic plaques. Increased periesophageal, paratracheal, bifurcation lymph nodes up to 2.5 cm in diameter, on the cut whitish color. Liver 1500 g with severe venous congestion, kidney 230 g with fine-grained surface and stroke scars.
Histological examination of a piece of visceral pericardium tumor as a dense infiltrate represented by solid clusters of polygonal tumor cells with marked cellular atypia, sometimes forming tubular structures of fibrous tissue. Strands of tumor tissue growing into the myocardium, a large number of tumor emboli in the vessels of the myocardium. Mediastinal lymph nodes, periesophageal, paratracheal, bifurcation replaced by tumor tissue.
Pathological diagnosis: Malignant diffuse nodular epithelioid mesothelioma of the pericardium with invasion into the myocardium. Tumor metastasis to mediastinal, periesophageal, paratracheal, bifurcation lymph nodes. Serosanguineous pericarditis. Phlebothrombosis deep veins of the right shin. Thromboembolism intraorgan small pulmonary artery branches. Venous congestion of internal organs, pulmonary edema. Hyperemia, edema, and swelling of the brain. Chronic bronchitis, diffuse pulmonary fibrosis and emphysema. Chronic pulmonary heart. Hypertension. Arteriolosklerotichesky nephrosclerosis and necrosis of the epithelium of the convoluted tubules. Atherosclerosis: Moderate - aortic arteries of the heart and brain. Melkoochagovy cardio.
Thus, in patients with malignant mesothelioma of the pericardium with tumor invasion and metastasis to the myocardium in the regional lymph nodes, as a manifestation of paraneoplastic syndrome, developed flebotromboz veins of the lower limb, followed by thromboembolism in the pulmonary artery, and that was the immediate cause of death. Vivo diagnosis of mesothelioma of the pericardium may be based on data on chest radiography, computed tomography, thoracoscopy with biopsy of the tumor study. However, the above observations are rare pathology and short stay patients in hospitals predetermined diagnostic error.
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