Surgical pathology of the parietal pericardium: A study of 344 cases (1993–1999)

doi:10.1016/S1054-8807(01)00076-X

Cardiovascular Pathology

Volume 10, Issue 4, July–August 2001, Pages 157-168

https://doi.org/10.1016/S1054-8807(01)00076-X Get rights and content

Abstract

Among 344 cases with surgically resected parietal pericardium, ages ranged from 1 to 87 years (mean, 55), and 64% were male. Causes of pericardial disease included neoplastic (33%), idiopathic (30%), iatrogenic (23%), and others (14%). Pericardial constriction (Group 1) represented the largest group (143 cases, 76% male). Maximal pericardial thickness was 1–17 mm (mean, 4). Fibrotic thickening occurred in 96%. Chronic lymphoplasmacytic inflammation affected 73% (mild or moderate in 97%). Calcification was uncommon (gross in 28%, microscopic in 8%), and granulomas were rare (4%, none tubercular). Constriction was idiopathic in 49% and iatrogenic (postpericardiotomy or postirradiation) in 41%. Neoplasms and cysts (Group 2) represented the second largest group (96 cases). Among 43 cases with secondary pericardial involvement, carcinomas accounted for 53% and lymphomas 21%. Forty cases (Group 3) had pericardial effusions (75% chronic), which were idiopathic in 28% and postpericardiotomy in 23%. Thirty-three cases (Group 4) had acute or recurrent pericarditis clinically, which was idiopathic in 70%. Lastly, 32 cases (Group 5) had pericardial resection for conditions unrelated to primary pericardial disease. In conclusion, pericardial constriction tended to be nontubercular (100%), nongranulomatous (96%), idiopathic or iatrogenic (90%), and noncalcific (64%), and it could occur with normal pericardial thickness (4%). Because considerable overlap in the gross and microscopic features existed among cases with noncalcific pericardial constriction (Group 1), pericardial effusions (Group 3), and pericarditis (Group 4), clinical information was necessary to provide an accurate clinicopathologic interpretation.

Introduction

Although valvular and ischemic diseases result in the greatest number of surgically excised specimens from the heart, pericardial disorders now represent an appreciable proportion of the cases at our institution. The reasons for pericardial resection are numerous, but have been described in only one surgical pathology series [1]. Given these considerations, the current study was undertaken to evaluate the pathology of pericardial disease in a relatively large number of surgical cases from a single institution.

Section snippets

Study group

All parietal pericardial specimens surgically excised at Mayo Clinic Rochester from January 1, 1993 through December 31, 1999 were reviewed, as approved by the Institutional Review Board. Of the 358 cases initially identified, 14 were excluded due to insufficient pericardium histologically, thus leaving a study group of 344 cases.

Clinical features

From medical charts, the age and gender of the patient and the duration, clinical diagnosis, and etiology of the pericardial disease were recorded. Duration was

Clinical features

Among the 341 patients, one had two pericardial operations and another had three, resulting in 344 cases. Ages at operation ranged from 1 to 87 years (mean, 55), and children were present in each of the five clinical categories (Table 1). Males accounted for 221 (64%) of the cases and were particularly prone to develop constriction.

Pericardial disease was chronic in 84% of the cases. It was neoplastic in 33%, idiopathic in 30%, iatrogenic in 23%, and of other cause in 14% (Table 2). The most

Discussion

Much has been written about the clinical features, causes, treatment, and operative results of pericardial diseases [3], [4], [5], [6], [7], [8]. However, little has been published concerning the pathology of surgically resected tissues [9], [10], [11], [12], [13], [14], [15], and only one consecutive series of all pericardial resections (35 patients) has been reported [1]. The current investigation uniquely reviewed the pathology of the parietal pericardium in a large number (344 specimens) of

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^☆: Presented in part as a poster on 14 October 2000 at the annual meeting of the American Society of Clinical Pathologists in San Diego, CA.

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Surgical pathology of the parietal pericardium: A study of 344 cases (1993–1999)☆

Abstract

Introduction

Section snippets

Study group

Clinical features

Clinical features

Discussion

Hum Pathol

Cardiol Clin

Cardiol Clin

Hum Pathol

J Thorac Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Am Heart J

Am Heart J

Am J Surg

Cardiol Clin

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Chest

Am J Cardiol

Am J Cardiol

Cardiol Clin

Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy

Circulation

Constrictive pericarditis: its history and current status

Clin Cardiol

Long-term experience with pericardiectomy: analysis of 105 consecutive patients

Thorac Cardiovasc Surg

Pericardial disease

Heart Dis Stroke

Acute pericarditis: etiology, treatment and prognosis. A study of 115 patients

Jpn Heart J

The pericardium: a comprehensive textbook

Constrictive pericarditis: a histopathological study of 91 cases

Indian Heart J

Constrictive pericarditis

Cardiol Clin