Malignant pericardial effusion in carcinoma of the uterine cervix

Abstract

The occurrence of malignant pericardial effusion is rare in squamous cell carcinoma of the uterine cervix. Only six cases of antemortem diagnosis have been reported. We report a patient with squamous cell carcinoma of the cervix who received emergent pericardiocentesis. In a few reported cases, women with pericardial involvement are candidates for radiation or chemotherapy. Early detection and prompt management of pericardial effusion is correlated with better quality of life and a decreased morbidity.

Cardiac Tamponade as an Initial Manifestation of Cervical Cancer

“…Cervical cancer is the second most common cancer diagnosed in women worldwide and the third cause of cancer death in developing countries [1, 3, 4]. The main sites for metastasis are the lung, the bone, and the brain [2].…”

“…The most common causes of pericardial effusion with or without tamponade are infections ( Coxsackievirus , VEB, CMV, and M. tuberculosis ); autoimmune diseases; cancer from lymphatic or hematogenous dissemination (metastasis: melanoma (50%), lung (30%), breast (12%), and lymphoma (12%)) [5, 9, 11, 12]; cardiac diseases (Dressler syndrome, myocarditis, and aortic dissection aneurysm); trauma; metabolic diseases (hypothyroidism, uremia, and ovary hyperstimulation); or drugs (cyclophosphamide, doxorubicin, gemcitabine, cytarabine, fludarabine, docetaxel, isoniazid, hydralazine, and phenytoin) [1, 13].…”

“…Cardiac tamponade causes hypotension, tachycardia, and decreased heart sounds (Beck triad). The paradoxical pulse is reported as the most sensitive sign (82%) to diagnose cardiac tamponade, followed by tachycardia and elevated jugular venous pressure with a sensitivity of 77% and 76%, respectively [1, 5, 13]. From the initial evaluation, the widening of the cardiac silhouette can be associated with the “water bottle sign” and the concomitant bilateral pleural effusion.…”

“…The EKG demonstrates low-voltage QRS and nonspecific T wave and ST segment changes. A transthoracic echocardiogram helps assess size, location, and hemodynamic physiology [1].…”

“…Pericardial metastasis is an unusual manifestation of cervical cancer, generally identified at autopsy [1]. Symptomatic pericardial effusion and cardiac tamponade are usually described in the scenario of recurrent disease after previous treatment with chemotherapy and/or radiotherapy, with very few cases reporting these entities as an initial presentation of cervical cancer [2].…”