Malignancy-related pericardial effusion. 127 cases from the roswell park cancer institute

Abstract

Background. Malignancy‐related pericardial effusions may represent a terminal event in patients with therapeutically unresponsive disease. However, select patients with malignancies sensitive to available therapies may achieve significant improvement in palliation and long term survival with prompt recognition and appropriate intervention. Methods. From 1968 to 1994, 150 invasive procedures were performed for the treatment or diagnosis of pericardial effusion in 127 patients with underlying malignancies. These cases were reviewed retrospectively to best identify the clinical features, appropriate diagnostic workup, and optimal therapy for this complication of malignancy. Results. Dyspnea (81%) and an abnormal pulsus paradoxus (32%) were the most common symptoms. Echocardiography had a 96% diagnostic accuracy. Cytology and pericardial biopsy had sensitivities of 90% and 56%, respectively. Fifty‐five percent of all effusions were malignant comprising 71% of adenocarcinomas of the lung, breast, esophagus, and unknown primary site. In 57 patients, a malignant effusion could not be determined, and no definitive etiology could be established for 74% of these effusions. Radiation‐induced, infectious, and hemorrhagic pericarditis each were identified in fewer than 5% of cases. Conclusions. Subxyphoid pericardiotomy proved to be a safe and effective intervention that successfully relieved pericardial effusions in 99% of cases with recurrence and reoperation rates of 9% and 7%, respectively. Survival most closely was related to the extent of disease and its inherent chemo‐/radiosensitivity, with 72% of the patients who survived longer than 1 year having breast cancer, leukemia, or lymphoma.

Neoplastic pericardial disease. Analysis of 26 patients

“…Most of our patients revealed electrocardiographic abnormalities (84%), although they were of a nonspecific type. There was a high incidence of low-voltage complexes, as seen also in the literature 5 , reflecting a diffuse involvement. In our series, there was a high positivity for pericardium biopsy associated with cytological analysis of the pericardial effusion (84%).…”

“…Frequently, the pericardial neoplastic disease has a subclinical course, thus the in vivo diagnosis many times is not suspected 4 . Autopsy studies revealed that only 20% to 64% of patients had a confirmed diagnosis while still alive 5,6 . In the majority of patients, chest radiography is abnormal, and pleural effusion is the most frequent feature 6,7 .…”

Altered Expression of Metastasis-Associated and Regulatory Molecules in Effusions from Breast Cancer Patients

“…Metastatic spread to serosal surfaces involves primarily the pleural cavity, where breast cancer is the etiology of approximately 25% of malignant effusions (2,3). However, breast carcinoma metastasis may be infrequently found in the pericardial and peritoneal cavity as well (4). Involvement of the pleural cavity by breast carcinoma may occur at any point of time of the clinical course and may be the sole manifestation of metastatic disease (5).…”

Purulent Pericarditis with Concurrent Detection of <i>Streptococcus pneumoniae</i> and Malignant Squamous Cells in Pericardial Fluid

“…In such patients, the mechanisms of development of pericardial effusion include direct metastasis to the pericardium, toxicity of chemotherapy or radiation, lymphatic drainage impairment, hypoalbuminemia and opportunistic infections. Malignant or radiation-induced effusions have been identified in most cases (17,18), whereas infection is thought to be a rare etiology of pericardial effusions in cancer patients.…”