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Pericardial Mesothelioma: Diagnostic and Therapeutic Management, a Population-Based Study in Italy
Simona Stella1, Dario Consonni1, Giovanni Luca Ceresoli2
1COR Lombardia, Occupational Health Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Background:
Pericardial mesothelioma (PM) is an extremely rare cancer with a poor prognosis and no consensus on diagnostic and therapeutic management. We conducted a registry-based study on PM cases in Italy diagnosed between 1993 and 2021.
Methods:
Based on data from the Italian National Mesothelioma Registry (ReNaM), we performed a descriptive analysis of PM cases including clinical presentation, diagnostic work-up, asbestos exposure, and therapeutic management. Overall survival was calculated. Hazard ratios (HRs) and 95% confidence intervals (CI) for selected variables were estimated with univariate and multivariate Cox models.
Results:
We identified 72 cases (46 men and 26 women). Median age was 66 years (range 22-89). The most frequent histological subtypes were epithelioid and unspecified mesothelioma. Almost two-thirds of cases had been exposed to asbestos. The most common clinical presentation was pericardial effusion. Overall median survival was 2.8 months (95% CI 1.2-6.6) and older age at diagnosis was a negative prognostic factor. Clinical and treatment data were available for 47 patients (65%). Approximately one out of two patients underwent surgery (palliative, in one-third of cases). Adjuvant therapy was administered to seven patients (15%). In cases with treatment information, sarcomatoid subtype (HR 2.74, 95% CI: 1.06-7.06) was a negative prognostic factor; adjuvant therapy was associated with better survival (HR 0.38, 95% CI 0.14-1.02), but confounding by indication cannot be excluded.
Conclusions:
We confirmed the very poor prognosis of PM. An international network collecting PM cases with treatment information is needed to improve patient quality of life and survival.
Insights
Pericardial mesothelioma (PM) is a rare cancer with a very poor prognosis. This study analyzed Italian cases, finding short survival and identifying asbestos exposure and older age as negative prognostic factors.
Area of Science:
- Oncology
- Epidemiology
- Public Health
Background:
- Pericardial mesothelioma (PM) is an extremely rare malignancy with a dismal prognosis.
- There is a lack of consensus regarding the optimal diagnostic and therapeutic strategies for PM.
- This study addresses the need for more data on PM through a comprehensive registry-based analysis.
Purpose of the Study:
- To describe the clinical characteristics, diagnostic work-up, asbestos exposure, and therapeutic management of PM cases.
- To analyze overall survival and identify prognostic factors in PM.
- To highlight the need for improved data collection and international collaboration for PM.
Main Methods:
- A descriptive analysis of 72 PM cases diagnosed in Italy between 1993 and 2021, using data from the Italian National Mesothelioma Registry (ReNaM).
- Calculation of overall survival and estimation of hazard ratios (HRs) and 95% confidence intervals (CIs) using univariate and multivariate Cox models.
- Inclusion of clinical presentation, asbestos exposure, histological subtypes, and treatment data.
Main Results:
- The median age of PM patients was 66 years, with epithelioid and unspecified subtypes being most common. Nearly two-thirds had asbestos exposure.
- The median overall survival was only 2.8 months. Older age at diagnosis and sarcomatoid subtype were negative prognostic factors.
- Surgery was performed in approximately half of treated patients; adjuvant therapy showed a trend towards better survival but requires further investigation due to potential confounding.
Conclusions:
- This study confirms the extremely poor prognosis associated with pericardial mesothelioma.
- Older age and sarcomatoid histology are significant negative prognostic indicators.
- An international network for collecting PM cases and treatment data is crucial for enhancing patient outcomes and survival.
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