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Lee J, Kim K, Gwak SY, Lee HJ, Cho I, Hong GR, Ha JW, Shim CY. Pericardiocentesis versus window formation in malignant pericardial effusion: trends and outcomes. Heart 2024; 110:863-871. [PMID: 38302262 DOI: 10.1136/heartjnl-2023-323542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/06/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES Malignant pericardial effusion (MPE) in patients with cancer is associated with poor prognosis. This study aimed to compare clinical outcomes in patients with cancer who underwent pericardiocentesis versus pericardial window formation. METHODS In the present study, 765 consecutive patients with cancer (mean age 58.4 years, 395 men) who underwent pericardial drainage between 2003 and 2022 were retrospectively analysed. All-cause death and MPE recurrence were compared based on the drainage method (pericardiocentesis vs pericardial window formation) and time period (period 1: 2003-2012; period 2: 2013-2022). RESULTS Pericardiocentesis was performed in 639 (83.5%) patients and pericardial window formation in 126 (16.5%). There was no difference in age, sex distribution, proportion of metastatic or relapsed cancer, and chemotherapy status between the pericardiocentesis and pericardial window formation groups. Difference was not found in all-cause death between the two groups (log-rank p=0.226) regardless of the period. The pericardial window formation group was associated with lower MPE recurrence than the pericardiocentesis group (6.3% vs 18.0%, log-rank p=0.001). This advantage of pericardial window formation was more significant in period 2 (18.1% vs 1.3%, log-rank p=0.005). In multivariate analysis, pericardial window formation was associated with lower MPE recurrence (HR: 0.31, 95% CI: 0.15 to 0.63, p=0.001); younger age, metastatic or relapsed cancer, and positive malignant cells in pericardial fluid were associated with increased recurrence. CONCLUSION In patients undergoing pericardial drainage for MPE, pericardial window formation showed mortality outcomes comparable with pericardiocentesis and was associated with lower incidence of MPE recurrence.
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Affiliation(s)
- Jaeoh Lee
- Yonsei University College of Medicine, Seoul, South Korea
| | - Kyu Kim
- Yonsei University College of Medicine, Seoul, South Korea
| | - Seo-Yeon Gwak
- Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun-Jung Lee
- Yonsei University College of Medicine, Seoul, South Korea
| | - Iksung Cho
- Yonsei University College of Medicine, Seoul, South Korea
| | - Geu-Ru Hong
- Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Won Ha
- Yonsei University College of Medicine, Seoul, South Korea
| | - Chi Young Shim
- Yonsei University College of Medicine, Seoul, South Korea
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Zhan W, Hu H, Hao B, Zhu H, Yan T, Zhang J, Wang S, Liu S, Zhang T. Development of machine learning-based malignant pericardial effusion-related model in breast cancer: Implications for clinical significance, tumor immune and drug-therapy. Heliyon 2024; 10:e27507. [PMID: 38463870 PMCID: PMC10923851 DOI: 10.1016/j.heliyon.2024.e27507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/30/2024] [Accepted: 02/29/2024] [Indexed: 03/12/2024] Open
Abstract
Background Malignant pericardial effusion (MPE) is a common complication of advanced breast cancer (BRCA) and plays an important role in BRCA. This study is aims to construct a prognostic model based on MPE-related genes for predicting the prognosis of breast cancer. Methods The BRCA samples are analyzed based on the expression of MPE-related genes by using an unsupervised cluster analysis method. This study processes the data by least absolute shrinkage and selection operator and multivariate Cox analysis, and uses machine learning algorithms to construct BRCA prognostic model and develop web tool. Results BRCA patients are classified into three clusters and a BRCA prognostic model is constructed containing 9 MPE-related genes. There are significant differences in signature pathways, immune infiltration, immunotherapy response and drug sensitivity testing between the high and low-risk groups. Of note, a web-based tool (http://wys.helyly.top/cox.html) is developed to predict overall survival as well as drug-therapy response of BRCA patients quickly and conveniently, which can provide a basis for clinicians to formulate individualized treatment plans. Conclusion The MPE-related prognostic model developed in this study can be used as an effective tool for predicting the prognosis of BRCA and provides new insights for the diagnosis and treatment of BRCA patients.
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Affiliation(s)
- Wendi Zhan
- School of Pharmacy, Hengyang Medical College, University of South China, 28 Western Changsheng Road, Hengyang, Hunan, 421001, China
- Department of Pharmacy, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Haihong Hu
- School of Pharmacy, Hengyang Medical College, University of South China, 28 Western Changsheng Road, Hengyang, Hunan, 421001, China
- Department of Pharmacy, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Bo Hao
- Department of Pharmacy, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Hongxia Zhu
- School of Pharmacy, Hengyang Medical College, University of South China, 28 Western Changsheng Road, Hengyang, Hunan, 421001, China
- Department of Pharmacy, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Ting Yan
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Jingdi Zhang
- School of Pharmacy, Hengyang Medical College, University of South China, 28 Western Changsheng Road, Hengyang, Hunan, 421001, China
- Department of Pharmacy, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Siyu Wang
- Department of Medical Oncology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Saiyang Liu
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250355, China
| | - Taolan Zhang
- Department of Pharmacy, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
- Phase I Clinical Trial Center, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
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Kim SM, Lee JH, Chung SR, Sung K, Kim WS, Cho YH. Pericardial Window Operation in Oncology Patients: Analysis of Long-Term Survival and Prognostic Factors. J Chest Surg 2024; 57:169-177. [PMID: 38228497 DOI: 10.5090/jcs.23.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/25/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024] Open
Abstract
Background Pericardial effusion (PE) is a serious condition in cancer patients, primarily arising from malignant dissemination. Pericardial window formation is a surgical intervention for refractory PE. However, the long-term outcomes and factors associated with postoperative survival remain unclear. Methods We retrospectively analyzed data from 166 oncology patients who underwent pericardial window formation at Samsung Medical Center between 2011 and 2023. We analyzed survival and PE recurrence regarding surgical approach, cancer type, and cytopathological findings. To identify factors associated with survival, we utilized Cox proportional-hazards regression. Results All patients had tumors documented in accordance with the American Joint Committee on Cancer staging manual, including lung (61.4%), breast (9.6%), gastrointestinal (9.0%), hematologic (3.6%), and other cancers (16.4%). Surgical approaches included mini-thoracotomy (67.5%) and thoracoscopy (32.5%). Postsurgical cytopathology confirmed malignancy in 94 cases (56.6%). Over a median follow-up duration of 50.0 months, 142 deaths and 16 PE recurrences occurred. The 1-year overall and PE recurrence-free survival rates were 31.4% and 28.6%, respectively. One-year survival rates were significantly higher for thoracoscopy recipients (43.7% vs. 25.6%, p=0.031) and patients with negative cytopathology results (45.1% vs. 20.6%, p<0.001). No significant survival difference was observed between lung cancer and other types (p=0.129). Multivariate analysis identified New York Heart Association class, cancer stage, and cytopathology as independent prognostic factors. Conclusion This series is the largest to date concerning window formation among cancer patients with PE. Patients' long-term survival after surgery was generally unfavorable. However, cases with negative cytopathology or earlier tumor stage demonstrated comparatively high survival rates.
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Affiliation(s)
- Sung Min Kim
- Department of Cardiovascular and Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Ho Lee
- Department of Cardiovascular and Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Ryeun Chung
- Department of Cardiovascular and Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kiick Sung
- Department of Cardiovascular and Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook Sung Kim
- Department of Cardiovascular and Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Hyun Cho
- Department of Cardiovascular and Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Choe JK, Byun AJ, Robinson E, Drake L, Tan KS, McAleer EP, Schaffer WL, Liu JE, Chen LL, Buchholz T, Yohannes-Tomicich J, Yarmohammadi H, Ziv E, Solomon SB, Huang J, Park BJ, Jones DR, Adusumilli PS. Management of Pericardial Effusion in Patients With Solid Tumor: An Algorithmic, Multidisciplinary Approach Results in Reduced Mortality After Paradoxical Hemodynamic Instability. Ann Surg 2024; 279:147-153. [PMID: 37800338 PMCID: PMC11010720 DOI: 10.1097/sla.0000000000006114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE This study compared outcomes in patients with solid tumor treated for pericardial effusion with surgical drainage versus interventional radiology (IR) percutaneous drainage and compared incidence of paradoxical hemodynamic instability (PHI) between cohorts. BACKGROUND Patients with advanced-stage solid malignancies may develop large pericardial effusions requiring intervention. PHI is a fatal and underreported complication that occurs following pericardial effusion drainage. METHODS Clinical characteristics and outcomes were compared between patients with solid tumors who underwent s urgical drainage or IR percutaneous drainage for pericardial effusion from 2010 to 2020. RESULTS Among 447 patients, 243 were treated with surgical drainage, of which 27 (11%) developed PHI, compared with 7 of 204 patients (3%) who were treated with IR percutaneous drainage ( P =0.002); overall incidence of PHI decreased during the study period. Rates of reintervention (30-day: 1% vs 4%; 90-day: 4% vs 6%, P =0.7) and mortality (30-day: 21% vs 17%, P =0.3; 90-day: 39% vs 37%, P =0.7) were not different between patients treated with surgical drainage and IR percutaneous drainage. For both interventions, OS was shorter among patients with PHI than among patients without PHI (surgical drainage, median [95% confidence interval] OS, 0.89 mo [0.33-2.1] vs 6.5 mo [5.0-8.9], P <0.001; IR percutaneous drainage, 3.7 mo [0.23-6.8] vs 5.0 mo [4.0-8.1], P =0.044). CONCLUSIONS With a coordinated multidisciplinary approach focusing on prompt clinical and echocardiographic evaluation, triage with bias toward IR percutaneous drainage than surgical drainage and postintervention intensive care resulted in lower incidence of PHI and improved outcomes.
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Affiliation(s)
- Jennie K Choe
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alexander J Byun
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric Robinson
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lauren Drake
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eileen P McAleer
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Wendy L Schaffer
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jennifer E Liu
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leon L Chen
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tara Buchholz
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joanna Yohannes-Tomicich
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hooman Yarmohammadi
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Etay Ziv
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephen B Solomon
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY
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Lee N, Bang H, Park H, Shim HJ. Case report: Successful treatment of malignant pericardial effusion with pericardiocentesis, concurrent anti-inflammatory therapy and cancer therapy. Front Cardiovasc Med 2023; 10:1285233. [PMID: 37900575 PMCID: PMC10601458 DOI: 10.3389/fcvm.2023.1285233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Despite significant advancements in systemic anticancer therapies, cardiac tamponade remains a serious and potentially life-threatening complication in metastatic breast cancer (MBC). However, there is a paucity of comprehensive research investigating alternative management approaches, such as pericardiocentesis and anti-inflammatory therapy (AIT), to effectively address cardiac tamponade and mitigate the risk of heart failure arising from constrictive physiology (CP) in patients with MBC when traditional systemic anticancer drugs fail to yield favorable outcomes. Herein, we describe two cases of MBC with cardiac tamponade that occurred despite the administration of effective systemic anticancer drugs. In each case, pericardial effusion was detected in a patient who was undergoing palliative anticancer therapy for human epidermal growth factor receptor 2 (HER2)-positive MBC. The patients in these cases were successfully treated with pericardiocentesis and AIT (prednisolone and colchicine) for subsequent CP without substitution with their systemic anticancer drugs. Cardiac tamponade and CP are regarded as signs of advanced cancer and are associated with a worse clinical outcome in general; however, they can still be treated with an effective anticancer drug, pericardiocentesis, and management of CP by cardiooncology specialists.
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Affiliation(s)
- Nuri Lee
- Department of Cardiology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Hyunjin Bang
- Department of Hematology and Oncology, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Republic of Korea
| | - Hyukjin Park
- Department of Cardiology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Hyun-Jeong Shim
- Department of Hematology and Oncology, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Republic of Korea
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Abusuliman M, Mohamed AM, Mahmoud A, Beliani T, Ismail-Sayed IM. Peritoneal Carcinoma Unveiling a Hidden Threat: A Case of Malignant Pericardial Effusion. Cureus 2023; 15:e46059. [PMID: 37900376 PMCID: PMC10605546 DOI: 10.7759/cureus.46059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Malignant pericardial effusion (MPE) is a slowly progressive and potentially clinically silent condition. Pericardial effusion can arise in oncology patients due to several factors, including disease spreading directly or metastatically, anticancer therapy side effects, or both. Solid and hematological malignancy metastasis more frequently involves the pericardium than primary tumors, with lung cancer being the most common metastatic tumor to involve the pericardium. While 5%-20% of all patients with metastatic neoplasms have pericardial involvement, MPE rarely appears with hemodynamic instability. Occasionally, MPE constitutes the initial manifestation of an underlying malignancy. Diagnosis and treatment require a multidisciplinary approach and a high degree of clinical suspicion. We present a case of a 59-year-old female with a history of peritoneal carcinoma who presented with persistent dyspnea on exertion following an episode of pneumonia that was treated with antibiotics. Physical examination and bedside point-of-care ultrasound (POCUS) revealed fluid in the pericardial sac. The cytological examination of the fluid revealed it to be of malignant origin, resulting from metastasis from gynecologic adenocarcinoma. Pericardiocentesis was done, and symptoms improved after fluid drainage.
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Affiliation(s)
| | - Amr M Mohamed
- Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Anas Mahmoud
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Tala Beliani
- Medicine, Kansas City University, Kansas City, USA
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Wei J, Shi Z, Song Z. Effects of intrapericardial administration after catheter drainage on malignant pericardial effusion in non-small cell lung cancer: A real-world study. Cancer Med 2023; 12:18211-18218. [PMID: 37533215 PMCID: PMC10523995 DOI: 10.1002/cam4.6404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/05/2023] [Accepted: 07/23/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Malignant pericardial effusion (MPE) is a serious complication of cancer that can be potentially deadly. It usually occurs in advanced or terminal stages of the disease, and as a result, patients with MPE often have a poor prognosis. There is a limited amount of research available that directly compares the effectiveness and safety of intrapericardial drug administration following pericardial drainage versus catheter drainage alone in non-small cell lung cancer (NSCLC) patients who have MPE. METHODS We retrospectively included 86 patients with NSCLC with MPE at Zhejiang Cancer Hospital. Survival and recurrence estimates were determined with the Kaplan-Meier method. RESULTS We divided the 86 patients with NSCLC into two groups: a pericardial drainage group (34 out of 86, 39.5%) and an intrapericardial administration group (52 out of 86, 60.5%). The response rates were 70.6% and 76.9% (p = 0.510), respectively. The median OS was 132.0 and 234.0 days (p = 0.579), respectively. The median time to recurrent drainage was 43.0 and 104.0 days (p = 0.170), respectively. The incidence of adverse events (AEs) was 44.1% and 61.5% (p = 0.113), respectively. The most frequent AEs were pain (27.9%) and fever (24.4%). Additionally, two patients in the intrapericardial administration group died of cardiac arrest. CONCLUSIONS Compared with catheter drainage alone, intrapericardial medication infusion during catheter drainage did not have significantly different effects. AEs require close monitoring and management.
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Affiliation(s)
- Jingwen Wei
- Department of Clinical TrialThe Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer HospitalHangzhouChina
- Postgraduate training base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital)HangzhouChina
| | - Zheng Shi
- Department of Clinical TrialThe Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer HospitalHangzhouChina
- Postgraduate training base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital)HangzhouChina
| | - Zhengbo Song
- Department of Clinical TrialThe Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer HospitalHangzhouChina
- Postgraduate training base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital)HangzhouChina
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Xu F, Ou D, Qi W, Wang S, Han Y, Cai G, Cao L, Xu C, Chen JY. Impact of multidisciplinary team on the pattern of care for brain metastasis from breast cancer. Front Oncol 2023; 13:1160802. [PMID: 37664027 PMCID: PMC10471195 DOI: 10.3389/fonc.2023.1160802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/18/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose The aim of this study was to explore how a multidisciplinary team (MDT) affects patterns of local or systematic treatment. Methods We retrospectively reviewed the data of consecutive patients in the breast cancer with brain metastases (BCBM) database at our institution from January 2011 to April 2021. The patients were divided into an MDT group and a non-MDT group. Results A total of 208 patients were analyzed, including 104 each in the MDT and non-MDT groups. After MDT, 56 patients (53.8%) were found to have intracranial "diagnosis upgrade". In the matched population, patients in the MDT group recorded a higher proportion of meningeal metastases (14.4% vs. 4.8%, p = 0.02), symptomatic tumor progression (11.5% vs. 5.8%, p = 0.04), and an increased number of occurrences of brain metastases (BM) progression (p < 0.05). Attending MDT was an independent factor associated with ≥2 courses of intracranial radiotherapy (RT) [odds ratio (OR) 5.4, 95% confidence interval (CI): 2.7-10.9, p < 0.001], novel RT technique use (7.0, 95% CI 3.5-14.0, p < 0.001), and prospective clinical research (OR 5.7, 95% CI 2.4-13.4, p < 0.001). Conclusion Patients with complex conditions are often referred for MDT discussions. An MDT may improve the qualities of intracranial RT and systemic therapy, resulting in benefits of overall survival for BC patients after BM. This encourages the idea that treatment recommendations for patients with BMBC should be discussed within an MDT.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jia-Yi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Hussain A, Prevatt O, Piercy J, Ahmed N, Marlowe S, Damaa G. A Rare Case of Non-Small-Cell Lung Carcinoma Complicated by Massive Pericardial Effusion and Cardiac Tamponade: A Case Report. Cureus 2023; 15:e44047. [PMID: 37746410 PMCID: PMC10517708 DOI: 10.7759/cureus.44047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
This case report presents a late middle-aged man with a right infra-hilar lung mass and pericardial effusion (PE). The patient was diagnosed with metastatic small-cell lung carcinoma, with metastases to the liver, pancreas, and cerebellum. The pericardial fluid cytology confirmed the presence of malignant cells most compatible with non-small-cell carcinoma. The patient received carbo/etoposide chemotherapy, and his treatment plan included adding atezolizumab and radiation therapy. Despite the excellent efficacy of immunotherapy, immune-related adverse events (IRAEs), including cardiac toxicity, were noted in some patients. PE related to immune checkpoint inhibitor (ICI) use is rare but potentially severe. This case highlights the importance of vigilant monitoring for cardiovascular symptoms during immunotherapy and the significance of pericardial fluid analysis in diagnosing malignant pericardial disease. Prompt diagnosis and appropriate treatment can lead to improved patient outcomes in cases of lung cancer-associated cardiac complications.
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Affiliation(s)
- Akbar Hussain
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
| | - Opal Prevatt
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
| | - Jonathan Piercy
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
| | - Nazneen Ahmed
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
| | - Stanley Marlowe
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
| | - Georges Damaa
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
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Hasegawa T, Arai Y, Sone M, Sugawara S, Itou C, Wada S, Umakoshi N, Kubo T, Kimura S, Kusumoto M. Clinical outcomes of image-guided percutaneous drainage of pericardial effusion in cancer patients: A single-center retrospective analysis. Asia Pac J Clin Oncol 2023; 19:257-262. [PMID: 35831984 DOI: 10.1111/ajco.13810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/08/2022] [Accepted: 06/13/2022] [Indexed: 01/20/2023]
Abstract
AIM Catheter removal, survival, and recurrence rates after percutaneous pericardial effusion drainage in cancer patients are not fully understood. We evaluated the clinical outcomes of image-guided percutaneous pericardial effusion drainage in cancer patients. METHODS From January 2014 to September 2017, 113 percutaneous drainages for symptomatic pericardial effusion were performed in 100 cancer patients (median 60 years; range, 7-84 years) using ultrasound or angio-computed tomography. An 8-Fr drainage catheter was placed using the Seldinger technique via the subxiphoid (n = 73), apical (n = 23), or left parasternal (n = 17) routes. Success rates, complications, and postprocedural clinical outcomes of drainages were retrospectively assessed. RESULTS The technical and clinical success rates were 100% and 99%, respectively, without major complications. The median duration of catheterization and evacuated pericardial effusion volume were 6 days (range, 1-72 days) and 970 ml (range, 140-7635 ml), respectively. Catheters were removed after the first drainage in 86 cases (86%). Symptomatic pericardial effusion recurred in nine patients after catheter removal, in whom redrainages were performed 13 times with a median duration to redrainage time of 48 days (range, 13-529 days). During the follow-up period (median 106 days [range, 1-1396 days]), 61 patients died. The median survival was 140 days (95% confidence interval [CI], 95-276 days), and the median catheter-free survival was 111 days (95% CI, 60-152 days). CONCLUSIONS Image-guided percutaneous pericardial effusion drainage for cancer patients is safe and helps alleviate symptoms. Additionally, catheter removal is possible in most patients, allowing a catheter-free period for patients.
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Affiliation(s)
- Tetsuya Hasegawa
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Chihiro Itou
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Shinji Wada
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Noriyuki Umakoshi
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Takatoshi Kubo
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Shintaro Kimura
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Masahiko Kusumoto
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
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Deser SB, Arapi B. Evaluation of etiology of pericardial effusion in 81 patients who underwent pericardiostomy or pericardial window. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2023. [DOI: 10.29333/jcei/12605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
<b>Introduction: </b>A wide variety of diseases lead to pericardial effusion including systemic inflammatory diseases, pericarditis, reduced pericardial fluid reabsorption due to increased systemic venous pressure, pneumonia, pulmonary embolism, endocrine diseases, post-cardiotomy syndrome, trauma, hypothyroidism, renal-hepatic failure, collagen-vascular diseases, infectious, and malignancy. In this study, we aimed to evaluate the underlying etiology of pericardial effusions in patients underwent surgical pericardial drainage or pericardial window and contemporary management.<br />
<b>Materials and methods: </b>Between January 2006 and January 2018, a total of 81 patients (49 males, 32 females; mean 52.9±10.6 years; range 5 to 84 years) who underwent subxiphoid pericardiostomy, pericardial window procedure with left anterior thoracotomy or subxiphoid approach, due to moderate or severe pericardial effusion and cardiac tamponade, were retrospectively analyzed.<br />
<b>Results: </b>Malignancy was diagnosed either with histopathological examination of the pericardial biopsy and/or fluid in 17 (80.9%) of 21 patients had a previous history of malignancy. Of the 21 patients diagnosed with malignancy, six patients (7.5%) had leukemia/lymphoma, and six patients (7.5%) had thyroid papillary cancer. Mycobacterium tuberculosis was identified in only one (1.2%) patient’s culture of the pericardial fluid. No etiology was found in the remaining 38 patients (46.9%); thus, they were considered as idiopathic pericarditis.<br />
<b>Conclusion: </b>Tuberculosis is no longer the leading cause of pericarditis. Idiopathic pericarditis is the leading cause of pericardial effusion and malignancy is the next most common cause of pericardial effusion in our region.
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Affiliation(s)
- Serkan Burc Deser
- Department of Cardiovascular Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Berk Arapi
- Department of Cardiovascular Surgery, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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12
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Hematologic and Oncologic Emergencies. Crit Care Nurs Q 2023; 46:100-113. [DOI: 10.1097/cnq.0000000000000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Muacevic A, Adler JR, Aiwuyo HO, Sedeta E, Uche I, Wasifuddin M, Perry JC. Breast Cancer Complicated by Cardiac Tamponade in a Patient With Neurofibromatosis Type 1. Cureus 2023; 15:e34095. [PMID: 36843810 PMCID: PMC9946274 DOI: 10.7759/cureus.34095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/24/2023] Open
Abstract
Pericardial effusion may occur as a result of malignant pericarditis, which may in turn result in cardiac tamponade. This paper reports on a rare case of cardiac tamponade that occurred in an African American patient with breast cancer and neurofibromatosis. Herein, we present a case of a 38-year-old woman with neurofibromatosis type 1 (NF1) and breast cancer. She presented with sudden shortness of breath and hypotension. Computed tomography of the chest and an echocardiogram confirmed the presence of cardiac tamponade. Symptomatic relief was obtained following an emergency pericardiocentesis. The patient experienced a recurrence of symptomatic pleuro-pericardial effusion, requiring repeat therapeutic pericardiocentesis and thoracocentesis. To eliminate accumulating fluid, an indwelling drain was placed. The clinical condition of the patient, however, continued to deteriorate and she expired a few days after admission. When patients with breast cancer present with dyspnea, clinicians should maintain a high index of suspicion of cardiac tamponade; urgent imaging should be performed to exclude tamponade. Further research is needed to identify the factors that predict cardiac tamponade in breast cancer patients as well as the optimal treatment for the condition. It is also necessary to examine the relationship between a history of neurofibromatosis and cardiac tamponade.
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14
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Muacevic A, Adler JR, Wasifuddin M, Hakobyan N, Aiwuyo HO, Perry JC, Uche I, Okhawere K, Torere BE, Burak E, Omid H, Wang JC. Cardiac Tamponade in Patients With Breast Cancer: A Systematic Review. Cureus 2022; 14:e33123. [PMID: 36721600 PMCID: PMC9884404 DOI: 10.7759/cureus.33123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 12/31/2022] Open
Abstract
Cardiac tamponade is a rare presentation in breast cancer and may be associated with poor prognosis. In this article, we reviewed the characteristics and survival outcomes of patients with breast cancer who developed cardiac tamponade. Three databases (PubMed, EMBASE and SCOPUS) were searched for relevant articles published from 1978 to 2022 and 16 articles were identified comprising 64 cases. The median age of the cases was 52 years. Cardiac tamponade was diagnosed with echocardiogram or computerized tomography of the chest or both in 91.9%, 1.6% and 6.5% of the cases, respectively. Cytology of the pericardial fluid was done in 90.5% of the cases while biopsy in addition to cytology was done in 9.5% of cases. Tamponade was proven to be malignant in 97.4% of the cases. The initial treatment for tamponade was pericardiocentesis. Adjunct therapies ranged from the insertion of a pericardial window, pericardiectomy, radiotherapy and chemotherapy. The median time from the first treatment of breast cancer to the onset of tamponade was 24 months while the median survival following diagnosis of tamponade was 13 months. There was no significant correlation (spearman rank-sum correlation coefficient= 0.35, p = 0.165) between time to tamponade (interval time from the first diagnosis of breast cancer and the onset of cardiac tamponade) and survival. Cardiac tamponade may adversely affect survival in patients with breast cancer. Early diagnosis with echocardiogram and cytology may guide management and expectations. Further observational studies are needed to determine the predictors of cardiac tamponade and optimal treatment in patients with breast cancer.
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15
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Quirk T, Yao Y, Sverdlov A, Murch S. Malignant pericardial effusions: A retrospective look at etiology and prognosis in a tertiary oncological center. Asia Pac J Clin Oncol 2022. [PMID: 35950292 DOI: 10.1111/ajco.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/20/2022] [Accepted: 07/24/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Cancer and the associated treatments are important causes of pericardial effusion. However, the natural history of malignant pericardial effusion is largely unknown, especially in the context of newer cancer treatments. We investigated the causes of pericardial effusions in a tertiary oncology center, with particular focus on the prognosis of malignant effusions in the era of contemporary oncological therapies. METHOD We obtained data from electronic medical records. Survival analyses were performed utilizing the Kaplan-Meier method. We performed Cox regression to explore the potential clinical factors associated with survival. RESULTS Forty-four patients had pericardial effusion treated with pericardiocentesis during the study period. The mean age was 62-years, and 55% were female. Sixty-eight percent of these patients also had cancer, with approximately half (47%) receiving prior chemotherapy, and a quarter (27%) having had chest radiotherapy. Seventy percent of the patients with active cancer had malignant cells on cytology of pericardial fluid. The median survival of the cohort was 227 days, with malignant effusions having a median survival of 62-days compared to nonmalignant effusions with 1408 days (Logrank statistic 7.4, p-value .007). Malignant cytology was significantly associated with mortality on univariable analysis (HR 2.5, 95% CI 1.2-5.3). Complication rates were low, with no deaths as a direct complication of pericardiocentesis. CONCLUSION Malignancy is the most common cause of pericardial effusion in this tertiary medical and oncological center. Abnormal cytology with malignant cells has a poor median survival, despite advances in oncological treatment over the last decade. Pericardiocentesis is a safe procedure for these patients.
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Affiliation(s)
- Thomas Quirk
- Department of Cardiology, Calvary Mater Hospital, Newcastle, New South Wales, Australia
| | - Yao Yao
- Department of Cardiology, Calvary Mater Hospital, Newcastle, New South Wales, Australia
| | - Aaron Sverdlov
- Department of Cardiology, Calvary Mater Hospital, Newcastle, New South Wales, Australia
| | - Stuart Murch
- Department of Cardiology, Calvary Mater Hospital, Newcastle, New South Wales, Australia
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16
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Almajed MR, Obri MS, Kamran W, Entz A. Malignant Cardiac Tamponade: A Complication of Untreated Breast Cancer. Cureus 2022; 14:e26787. [PMID: 35967180 PMCID: PMC9366026 DOI: 10.7759/cureus.26787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/24/2022] Open
Abstract
Carcinomatous pericarditis is a rare complication of locally aggressive breast cancer in which malignant cells directly extend into the pericardium causing inflammation and creating a pericardial effusion. A 40-year-old woman with untreated metastatic breast cancer presented to an outpatient clinic in significant distress with symptoms of progressive shortness of breath and bilateral leg swelling. An urgent echocardiogram demonstrated a large pericardial effusion with echocardiographic evidence of cardiac tamponade. She underwent emergent pericardiocentesis of the effusion that was deemed to be malignant after cytologic evaluation. Subsequently, she opted for palliative treatment involving the surgical creation of a right pericardial window and placement of an indwelling pleural catheter. Internists should maintain a high index of suspicion for malignant cardiac tamponade in at-risk patients, especially those with locally aggressive and advanced malignancies.
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17
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Shiryaev AA, Minaev VV, Stolyarov VI, Efendiev KT, Fatyanova AS, Zhemerikin GA, Agakina YS, Aleynikova AR, Shchekoturov IO, Parshin VD, Reshetov IV, Loschenov VB. A method for intra-percardial PDT for malignant mesothelioma. Photodiagnosis Photodyn Ther 2022; 38:102799. [PMID: 35276346 DOI: 10.1016/j.pdpdt.2022.102799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 11/19/2022]
Abstract
We describe a case of a 35-year-old patient with recurrent non-resectable pleural mesothelioma cT4N0M0 with a confirmed malignant pericardial effusion, threatening for cardiac tamponade. We performed and described our experience of intrapericardial photodynamic therapy which was well tolerated and with a good survival result. After 12 months of follow-up our patient showed no signs of pericardial effusion and in stable condition, keeping high level of quality of life. This clinical case is an example of the excellent palliative effect of photodynamic therapy together with concomitant immunotherapy.
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Affiliation(s)
- Artem A Shiryaev
- Department of Oncology and Plastic Surgery, Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of the Russian Federation, Moscow 119146, Russian Federation
| | - Vadim V Minaev
- Department of Oncology and Plastic Surgery, Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of the Russian Federation, Moscow 119146, Russian Federation
| | - Vladimir I Stolyarov
- Department of Oncology and Plastic Surgery, Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of the Russian Federation, Moscow 119146, Russian Federation.
| | - Kanamat T Efendiev
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova st., 38, Moscow 119991, Russian Federation; National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Kashirskoe sh., 31, Moscow 115409, Russian Federation
| | - Anastasia S Fatyanova
- Department of Oncology and Plastic Surgery, Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of the Russian Federation, Moscow 119146, Russian Federation; Department of Oncology and Plastic Surgery, Academy of Postgraduate Education FSBI FNCC FMBA of Russia, Volokolamskoe sh., 91, Moscow 125371, Russian Federation
| | - Gleb A Zhemerikin
- Department of Oncology and Plastic Surgery, Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of the Russian Federation, Moscow 119146, Russian Federation
| | - Yulia S Agakina
- Department of Oncology and Plastic Surgery, Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of the Russian Federation, Moscow 119146, Russian Federation; Department of Oncology and Plastic Surgery, Academy of Postgraduate Education FSBI FNCC FMBA of Russia, Volokolamskoe sh., 91, Moscow 125371, Russian Federation
| | - Anastasia R Aleynikova
- Department of Oncology and Plastic Surgery, Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of the Russian Federation, Moscow 119146, Russian Federation
| | - Igor O Shchekoturov
- Department of Oncology and Plastic Surgery, Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of the Russian Federation, Moscow 119146, Russian Federation
| | - Vladimir D Parshin
- Department of Oncology and Plastic Surgery, Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of the Russian Federation, Moscow 119146, Russian Federation; Department of Oncology and Plastic Surgery, Academy of Postgraduate Education FSBI FNCC FMBA of Russia, Volokolamskoe sh., 91, Moscow 125371, Russian Federation
| | - Igor V Reshetov
- Department of Oncology and Plastic Surgery, Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of the Russian Federation, Moscow 119146, Russian Federation; Department of Oncology and Plastic Surgery, Academy of Postgraduate Education FSBI FNCC FMBA of Russia, Volokolamskoe sh., 91, Moscow 125371, Russian Federation
| | - Victor B Loschenov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova st., 38, Moscow 119991, Russian Federation; National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Kashirskoe sh., 31, Moscow 115409, Russian Federation
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18
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Tyebally S, Ghose A, Chen DH, Abiodun AT, Ghosh AK. Chest Pain in the Cancer Patient. Eur Cardiol 2022; 17:e15. [PMID: 35702571 PMCID: PMC9185574 DOI: 10.15420/ecr.2021.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/10/2022] [Indexed: 11/30/2022] Open
Abstract
Chest pain is one of the most common presenting symptoms in patients seeking care from a physician. Risk assessment tools and scores have facilitated prompt diagnosis and optimal management in these patients; however, it is unclear as to whether a standardised approach can adequately triage chest pain in cancer patients and survivors. This is of concern because cancer patients are often at an increased risk of cardiovascular mortality and morbidity given the shared risk factors between cancer and cardiovascular disease, compounded by the fact that certain anti-cancer therapies are associated with an increased risk of cardiovascular events that can persist for weeks and even years after treatment. This article describes the underlying mechanisms of the most common causes of chest pain in cancer patients with an emphasis on how their management may differ to that of non-cancer patients with chest pain. It will also highlight the role of the cardio-oncology team, who can aid in identifying cancer therapy-related cardiovascular side-effects and provide optimal multidisciplinary care for these patients.
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Affiliation(s)
- Sara Tyebally
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Aruni Ghose
- Oncology Department, St Bartholomew’s Hospital, London, UK
| | - Daniel H Chen
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London, UK; Hatter Cardiovascular Institute, UCL Institute of Cardiovascular Science, University College London Hospital, London, UK
| | - Aderonke T Abiodun
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Arjun K Ghosh
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London, UK; Hatter Cardiovascular Institute, UCL Institute of Cardiovascular Science, University College London Hospital, London, UK
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19
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Ahmed T, Mouhayar E, Song J, Koutroumpakis E, Palaskas NL, Yusuf SW, Lopez-Mattei J, Hassan SA, Kim P, Cilingiroglu M, Marmagkiolis K, Vaporciyan AA, Swisher S, Deswal A, Iliescu C. Predictors of Recurrence and Survival in Cancer Patients With Pericardial Effusion Requiring Pericardiocentesis. Front Cardiovasc Med 2022; 9:916325. [PMID: 35711368 PMCID: PMC9192944 DOI: 10.3389/fcvm.2022.916325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/10/2022] [Indexed: 11/27/2022] Open
Abstract
Aim This study investigated the factors predicting survival and the recurrence of pericardial effusion (PE) requiring pericardiocentesis (PCC) in patients with cancer. Materials and Methods We analyzed the data of patients who underwent PCC for large PEs from 2010 to 2020 at The University of Texas MD Anderson Cancer Center. The time to the first recurrent PE requiring PCC was the interval from the index PCC with pericardial drain placement to first recurrent PE requiring drainage (either repeated PCC or a pericardial window). Univariate and multivariate Fine-Gray models accounting for the competing risk of death were used to identify predictors of recurrent PE requiring drainage. Cox regression models were used to identify predictors of death. Results The study cohort included 418 patients with index PCC and pericardial drain placement, of whom 65 (16%) had recurrent PEs requiring drainage. The cumulative incidences of recurrent PE requiring drainage at 12 and 60 months were 15.0% and 15.6%, respectively. Younger age, anti-inflammatory medication use, and solid tumors were associated with an increased risk of recurrence of PE requiring drainage, and that echocardiographic evidence of tamponade at presentation and receipt of immunotherapy were associated with a decreased risk of recurrence. Factors predicting poor survival included older age, malignant effusion on cytology, non-use of anti-inflammatory agents, non-lymphoma cancers and primary lung cancer. Conclusion Among cancer patients with large PEs requiring drainage, young patients with solid tumors were more likely to experience recurrence, while elderly patients and those with lung cancer, malignant PE cytology, and non-use of anti-inflammatory agents showed worse survival.
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Affiliation(s)
- Talha Ahmed
- Department of Cardiology, The University of Texas Health Science Center at Houston, Houston, TX, United States
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elie Mouhayar
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Juhee Song
- Department of Biostatistics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Efstratios Koutroumpakis
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nicolas L. Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Syed Wamique Yusuf
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Saamir A. Hassan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Peter Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mehmet Cilingiroglu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Konstantinos Marmagkiolis
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ara A. Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Stephen Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anita Deswal
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Cezar Iliescu,
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20
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Imai H, Kaira K, Masubuchi K, Minato K. Management of Lung Cancer-Associated Malignant Pericardial Effusion with Intrapericardial Administration of Carboplatin: A Retrospective Study. Curr Oncol 2021; 29:163-172. [PMID: 35049689 PMCID: PMC8774651 DOI: 10.3390/curroncol29010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
It has been reported that 5.1–7.0% of acute pericarditis are carcinomatous pericarditis. Malignant pericardial effusion (MPE) can progress to cardiac tamponade, which is a life-threatening condition. The effectiveness and feasibility of intrapericardial instillation of carboplatin (CBDCA; 150 mg/body) have never been evaluated in patients with lung cancer, which is the most common cause of MPE. Therefore, we evaluated the effectiveness and feasibility of intrapericardial administration of CBDCA following catheter drainage in patients with lung cancer-associated MPE. In this retrospective study, 21 patients with symptomatic lung cancer-associated MPE, who were administered intrapericardial CBDCA (150 mg/body) at Gunma Prefectural Cancer Center between January 2005 and March 2018, were included. The patients’ characteristics, response to treatment, and toxicity incidence were evaluated. Thirty days after the intrapericardial administration of CBDCA, MPE was controlled in 66.7% of the cases. The median survival period from the day of administration until death or last follow-up was 71 days (range: 10–2435 days). Grade 1–2 pain, nausea, fever, and neutropenia were noted after intrapericardial CBDCA administration. No treatment-related deaths were noted in the current study. Intrapericardial administration of CBDCA (150 mg/body) did not cause serious toxicity, and patients exhibited promising responses to lung cancer-associated MPE. Prospective studies using larger sample sizes are needed to explore the efficacy and safety of this treatment for managing lung cancer-associated MPE.
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Affiliation(s)
- Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota 373-8550, Japan; (K.M.); (K.M.)
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka 350-0495, Japan;
- Correspondence: ; Tel.: +81-276-38-0771; Fax: +81-276-38-0614
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka 350-0495, Japan;
| | - Ken Masubuchi
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota 373-8550, Japan; (K.M.); (K.M.)
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota 373-8550, Japan; (K.M.); (K.M.)
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21
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Song MJ, Jo U, Jeong JS, Cho KJ, Gong G, Cho YM, Song JS. Clinico-cytopathologic analysis of 574 Pericardial Effusion Specimens: Application of the international system for reporting serous fluid cytopathology (ISRSFC) and long-term clinical follow-up. Cancer Med 2021; 10:8899-8908. [PMID: 34747147 PMCID: PMC8683522 DOI: 10.1002/cam4.4408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/22/2021] [Accepted: 10/25/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION A pericardial effusion (PE) has a variable etiology and the primary role is diagnosis of metastatic malignancy. We analyzed the PE cytology in a large cohort in accordance with the international system for reporting serous fluid cytopathology (ISRSFC) and evaluated the long-term patient outcomes. METHODS PE specimens from 2010 to 2014 with an available clinical history, cytologic data, and pericardial biopsy results were collected. RESULTS A total of 574 PE specimens were obtained from 486 patients, representing 1.5% (574/38,589) of all body fluid specimens. Three hundred and eighty-two (66.6%) cases were "negative," 54 (9.4%) cases were "atypia of undetermined significance," 10 (1.7%) cases were "suspicious for malignancy," and 128 (22.3%) cases were "malignancy". The most common origin for malignant PE was the lung (82.1%), in both men (70.5%) and women (50.6%). Breast cancer (20%) in women and gastric cancer (4.9%) in men were the second most common malignant PE, respectively. The mean interval from the occurrence of malignant PE to death was 10.06 months (range; 0-116.03 months, median 3.5 months), and the 1-year survival rate was 16.7%. In addition, the 1-year survival rates after malignant PE onset were 0% for gastric cancer, 13.9% for lung cancer, 19.8% for breast cancer, and 21.1% for the other cancers (p = 0.011). CONCLUSION Our present study is the first to our knowledge to classify the pericardial fluid from 574 cases in accordance with the recently published ISRSFC, and to present the long-term outcomes of patients with malignant PE at the same time. Moreover, we report for the first time that it is gastric and not lung cancer patients that have the poorest prognosis after the occurrence of malignant PE.
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Affiliation(s)
- Min Jeong Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Uiree Jo
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Seon Jeong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Ja Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Mee Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Seon Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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22
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Park H, Yoon HJ, Lee N, Kim JY, Kim HY, Cho JY, Kim KH, Ahn Y, Jeong MH, Cho JG. Characteristics and Clinical Outcomes of Cancer Patients Who Developed Constrictive Physiology after Pericardiocentesis. Korean Circ J 2021; 52:74-83. [PMID: 34877827 PMCID: PMC8738712 DOI: 10.4070/kcj.2021.0217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study aimed to identify the characteristics and clinical outcomes of cancer patients who developed constrictive physiology (CP) after percutaneous pericardiocentesis. METHODS One-hundred thirty-three cancer patients who underwent pericardiocentesis were divided into 2 groups according to follow-up echocardiography (CP vs. non-CP). The clinical history, imaging findings, and laboratory results, and overall survival were compared. RESULTS CP developed in 49 (36.8%) patients after pericardiocentesis. The CP group had a more frequent history of radiation therapy. Pericardial enhancement and malignant masses abutting the pericardium were more frequently observed in the CP group. Fever and ST segment elevation were more frequent in the CP group, with higher C-reactive protein levels (6.6±4.3mg/dL vs. 3.3±2.5mg/dL, p<0.001). Pericardial fluid leukocytes counts were significantly higher, and positive cytology was more frequent in the CP group. In baseline echocardiography before pericardiocentesis, medial e' velocity was significantly higher in the CP group (8.6±2.1cm/s vs. 6.5±2.3cm/s, p<0.001), and respirophasic ventricular septal shift, prominent expiratory hepatic venous flow reversal, pericardial adhesion, and loculated pericardial fluid were also more frequent. The risk of all-cause death was significantly high in the CP group (hazard ratio, 1.53; 95% confidence interval,1.10-2.13; p=0.005). CONCLUSIONS CP frequently develops after pericardiocentesis, and it is associated with poor survival in cancer patients. Several clinical signs, imaging, and laboratory findings suggestive of pericardial inflammation and/or direct malignant pericardial invasion are frequently observed and could be used as predictors of CP development.
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Affiliation(s)
- Hyukjin Park
- Department of Cardiology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hyun Ju Yoon
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea.
| | - Nuri Lee
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea
| | - Jong Yoon Kim
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea
| | - Hyung Yoon Kim
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea
| | - Jae Yeong Cho
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea
| | - Kye Hun Kim
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea
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Queiroz CMD, Cardoso J, Ramires F, Ianni B, Hotta VT, Mady C, Buck PDC, Dias RR, Nastari L, Fernandes F. Pericardial Effusion and Cardiac Tamponade: Etiology and Evolution in the Contemporary Era. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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24
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Rahman AU, Folaranmi O, Chan V, Chaudary A. Anaplastic Lymphoma Kinase-Positive Primary Lung Adenocarcinoma Presenting With Pericardial Effusion and Tamponade in a COVID-19 Patient: A Case Report. Cureus 2021; 13:e19127. [PMID: 34868767 PMCID: PMC8627680 DOI: 10.7759/cureus.19127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/23/2022] Open
Abstract
Primary lung cancer usually presents in older adults with a smoking history. However, there is an estimated incidence of 15-20% among men who have never smoked. The diagnosis of lung malignancy can often be incidental. Moreover, cardiac tamponade can be an initial presentation of malignancy, especially lung cancer, as these are the most common tumors that involve the pericardium. Here, we present a 54-year-old male with no known medical history presented with dyspnea on exertion. He was found to have a large pericardial effusion with tamponade physiology on a bedside echocardiogram. He was also found to have bilateral deep vein thrombosis and pulmonary embolism on admission. The patient underwent an emergent pericardiocentesis due to hemodynamic compromise, and pericardial fluid cytology suggested adenocarcinoma with lung primary. Subsequently, gene testing revealed anaplastic lymphoma kinase-positive adenocarcinoma of the lung. The patient was discharged home with close oncology follow-up. It is imperative to recognize malignant pericardial effusion as one of the causes of dyspnea. Emergent pericardiocentesis may be needed in case of hemodynamic compromise and tenuous clinical status.
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Affiliation(s)
| | | | - Vernon Chan
- Internal Medicine, WellSpan York Hospital, York, USA
| | - Amna Chaudary
- Internal Medicine, WellSpan York Hospital, York, USA
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25
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Zhang Y, Zou JY, Xu YY, He JN. Fruquintinib beneficial in elderly patient with neoplastic pericardial effusion from rectal cancer: A case report. World J Clin Cases 2021; 9:6170-6177. [PMID: 34368339 PMCID: PMC8316928 DOI: 10.12998/wjcc.v9.i21.6170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/07/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neoplastic pericardial effusion (NPE) is a rare consequence of rectal cancer and carries a poor prognosis. Optimal management has yet to be determined. Fruquintinib is an oral anti-vascular endothelial growth factor receptor tyrosine kinase inhibitor approved by the China Food and Drug Administration in September 2018 as third-line treatment of metastatic colorectal cancer.
CASE SUMMARY Herein, we report an elderly patient with NPE from rectal cancer who responded to the use of fruquintinib. In March 2015, a 65-year-old Chinese woman diagnosed with KRAS-mutated adenocarcinoma of the rectum was subjected to proctectomy, adjuvant concurrent chemoradiotherapy, and adjuvant chemotherapy. By October 2018, a mediastinal mass was detected via computed tomography. The growth had invaded parietal pericardium and left hilum, displaying features of rectal adenocarcinoma in a bronchial biopsy. FOLFIRI and FOLFOX chemotherapeutic regimens were administered as first- and second-line treatments. After two cycles of second-line agents, a sizeable pericardial effusion resulting in tamponade was drained by pericardial puncture. Fluid cytology showed cells consistent with rectal adenocarcinoma. Single-agent fruquintinib was initiated on January 3, 2019, as a third-line therapeutic. Ten cycles were delivered before the NPE recurred and other lesions progressed. The recurrence-free interval for NPE was 9.2 mo, attesting to the efficacy of fruquintinib. Ultimately, the patient entered a palliative care unit for best supportive care.
CONCLUSION Fruquintinib may confer good survival benefit in elderly patients with NPEs due to rectal cancer.
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Affiliation(s)
- Ying Zhang
- Department of Clinical Oncology, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
| | - Jia-Yun Zou
- Department of Clinical Oncology, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
| | - Yan-Yan Xu
- Department of Clinical Oncology, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
| | - Jing-Ni He
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
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26
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Nakamura T, Okune M, Yasuda M, Watanabe H, Ueno M, Yamaji K, Mizutani K, Kurita T, Nakazawa G. Impact of pericardial fluid glucose level and computed tomography attenuation values on diagnosis of malignancy-related pericardial effusion. BMC Cardiovasc Disord 2021; 21:272. [PMID: 34082695 PMCID: PMC8176742 DOI: 10.1186/s12872-021-02091-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/27/2021] [Indexed: 11/20/2022] Open
Abstract
Background We evaluated malignancy according to the characteristics of pericardial fluid in symptomatic Japanese patients undergoing pericardiocentesis and computed tomography (CT). Methods This was a retrospective, single-center, observational study of 125 symptomatic patients undergoing pericardiocentesis. The patients were classified into two groups: a malignancy group and a non-malignancy group, according to the primary disease and cytology of the pericardial effusion (PE). We compared the pericardial fluid sample and CT measurements between both groups. Results All patients were diagnosed as having exudative PE by Light’s criteria. PE with malignant cells was demonstrated in 76.8% of the malignancy group patients. Pericardial to serum lactate dehydrogenase (LDH) ratio > 0.6, as one of Light’s criteria, was associated with malignancy (p = 0.017). Lower serum brain natriuretic peptide (BNP) concentration was also associated with malignancy (BNP: 126.9 ± 89.8 pg/ml vs 409.2 ± 97.7 pg/ml, malignancy vs non-malignancy groups, respectively; p = 0.037). A significant difference was observed in pericardial fluid glucose level between the malignancy and non-malignancy groups (pericardial fluid glucose: 78.24 ± 48.29 mg/dl vs 98.41 ± 44.85, respectively; p = 0.048). Moreover, CT attenuation values (Hounsfield units (HU)) tended to be higher in the malignancy group vs the non-malignancy group (22.7 [interquartile range (IQR), 17.4–26.0] vs 17.4 [IQR, 13.7–26.4], respectively; p = 0.08). The sensitivity and specificity of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were 40.9% and 89.6%, respectively, in the malignancy group. The positive- and negative predictive values of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were 85.7% and 50.0%, respectively, in the malignancy group. Pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were cutoff values associated with malignancy (p = 0.012). Conclusions Lower pericardial fluid glucose level with higher CT attenuation values may suggest malignancy-related PE. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02091-6.
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Affiliation(s)
- Takashi Nakamura
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, 589-8511, Japan
| | - Mana Okune
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, 589-8511, Japan
| | - Masakazu Yasuda
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, 589-8511, Japan
| | - Heitaro Watanabe
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, 589-8511, Japan
| | - Masafumi Ueno
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, 589-8511, Japan
| | - Kenji Yamaji
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, 589-8511, Japan
| | - Kazuki Mizutani
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, 589-8511, Japan
| | - Takashi Kurita
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, 589-8511, Japan
| | - Gaku Nakazawa
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, 589-8511, Japan.
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27
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Zhou C, Li S, Liu J, Chu Q, Miao L, Cai L, Cai X, Chen Y, Cui F, Dong Y, Dong W, Fang W, He Y, Li W, Li M, Liang W, Lin G, Lin J, Lin X, Liu H, Liu M, Mu X, Hu Y, Hu J, Jin Y, Li Z, Qin Y, Ren S, Sun G, Shen Y, Su C, Tang K, Wu L, Wang M, Wang H, Wang K, Wang Y, Wang P, Wang H, Wang Q, Wang Z, Xie X, Xie Z, Xu X, Xu F, Yang M, Yang B, Yi X, Ye X, Ye F, Yu Z, Yue D, Zhang B, Zhang J, Zhang J, Zhang X, Zhang W, Zhao W, Zhu B, Zhu Z, Zhong W, Bai C, Chen L, Han B, Hu C, Lu S, Li W, Song Y, Wang J, Zhou C, Zhou J, Zhou Y, Saito Y, Ichiki Y, Igai H, Watanabe S, Bravaccini S, Fiorelli A, Petrella F, Nakada T, Solli P, Tsoukalas N, Kataoka Y, Goto T, Berardi R, He J, Zhong N. International consensus on severe lung cancer-the first edition. Transl Lung Cancer Res 2021; 10:2633-2666. [PMID: 34295668 PMCID: PMC8264326 DOI: 10.21037/tlcr-21-467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/17/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Chengzhi Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shiyue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jun Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Qian Chu
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Liyun Miao
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Linbo Cai
- Department of Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Xiuyu Cai
- Department of General Internal Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yu Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fei Cui
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yuchao Dong
- Department of Pulmonary and Critical Care Medicine, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wen Dong
- Department of Oncology, Hainan Cancer Hospital, Haikou, China
| | - Wenfeng Fang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yong He
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Weifeng Li
- Department of Respiratory Medicine, General Hospital of Guangzhou Military Command of PLA, Guangzhou, China
| | - Min Li
- Department of Respiratory Medicine, Xiangya Cancer Center, Xiangya Hospital, Central South University, Changsha, China
| | - Wenhua Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Gen Lin
- Department of Thoracic Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Jie Lin
- Department of Medical Oncology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xinqing Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Hongbing Liu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Ming Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xinlin Mu
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Yi Hu
- Department of Medical Oncology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Jie Hu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yang Jin
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziming Li
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yinyin Qin
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Gengyun Sun
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yihong Shen
- Department of Respiratory Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chunxia Su
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kejing Tang
- Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Institute of Pulmonary Diseases, Sun Yat-sen University, Guangzhou, China
| | - Lin Wu
- Thoracic Medicine Department II, Hunan Cancer Hospital, Changsha, China
| | - Mengzhao Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Huijuan Wang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Kai Wang
- Department of Respiratory Medicine, Fourth Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yuehong Wang
- Department of Respiratory Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ping Wang
- Department of Respiratory and Critical Care Medicine, the Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Hongmei Wang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qi Wang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhijie Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohong Xie
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhanhong Xie
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xin Xu
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fei Xu
- Department of Respiratory Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Meng Yang
- Department of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
| | - Boyan Yang
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.,Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangjun Yi
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoqun Ye
- Department of Respiratory Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Feng Ye
- Department of Medical Oncology, The first affiliated hospital of Xiamen University, Xiamen, China
| | - Zongyang Yu
- Department of Pulmonary and Critical Care Medicine, The th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Dongsheng Yue
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Bicheng Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jian Zhang
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jianqing Zhang
- Second Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoju Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Zhao
- Department of Pulmonary and Critical Care Medicine, The General Hospital of People's Liberation Army, Beijing, China
| | - Bo Zhu
- Institute of Cancer, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Wenzhao Zhong
- Guangdong Lung Cancer Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chunxue Bai
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liangan Chen
- Department of Respiratory, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Baohui Han
- Department of Pulmonology, Shanghai Chest Hospital, Shanghai, China
| | - Chengping Hu
- Department of Pulmonary Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Shun Lu
- Department of Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Song
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing, China
| | - Jie Wang
- Key Laboratory of Respiratory Disease Pathogenomics, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Caicun Zhou
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianying Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Yanbin Zhou
- Department of Internal Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuichi Saito
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshinobu Ichiki
- Department of General Thoracic Surgery, National Hospital Organization, Saitama Hospital, Wako, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sara Bravaccini
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Universitàdella Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Petrella
- Division of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Takeo Nakada
- Division of Thoracic Surgery, Department of Surgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Piergiorgio Solli
- Department of Cardio-Thoracic Surgery and Hearth & Lung Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan
| | - Taichiro Goto
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, Italy
| | - Jianxing He
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
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28
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Sadiq AM, Sadiq AM, Nkya GZ. Advanced lung cancer presenting with malignant pericardial effusion. Clin Case Rep 2021; 9:e04179. [PMID: 34194771 PMCID: PMC8222753 DOI: 10.1002/ccr3.4179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 12/13/2022] Open
Abstract
Irregular pericardial wall thickening, mediastinal lymph nodes, and pericardial fluid analysis are helpful to identify metastasis to the pericardium though it is a marker of advanced disease and poor prognosis.
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Affiliation(s)
- Abid M. Sadiq
- Department of Internal MedicineKilimanjaro Christian Medical CentreMoshiTanzania
- Kilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Adnan M. Sadiq
- Kilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of RadiologyKilimanjaro Christian Medical CentreMoshiTanzania
| | - Gilbert Z. Nkya
- Kilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of PathologyKilimanjaro Christian Medical CentreMoshiTanzania
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29
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Abstract
Despite the monumental advances in the diagnoses and therapeutics of malignancy, several cancer patients have presented with pericardial involvement, including acute pericarditis, constrictive pericarditis, and pericardial effusion. Multiple factors can contribute to acute pericarditis, including direct metastasis to the heart, pericardial hemorrhage, infections due to immunosuppression, and cancer therapies that include chemotherapy, immunotherapy, and radiation. Pericardial effusion, either due to cancer invasion or cancer treatment, is one of the most common incidental findings in cancer patients, which significantly worsens morbidity and mortality. If left untreated, pericardial effusion is known to cause complications such as pericardial tamponade. Constrictive pericarditis can be due to radiation exposure, chemotherapy, or is a sequela of a previous episode of acute pericarditis. In conclusion, early detection, prompt treatment, and understanding of pericardial diseases are necessary to help improve the quality of life of cancer patients, and we aim to summarize the knowledge of pericardial involvement in patients with cancer.
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30
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Pulmonary hypertension concurrent with pericardial effusion and superior vena cava syndrome: who is the initiator? J Geriatr Cardiol 2020; 17:723-727. [PMID: 33343651 PMCID: PMC7729177 DOI: 10.11909/j.issn.1671-5411.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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31
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Miyawaki T, Wakuda K, Kenmotsu H, Miyawaki E, Mamesaya N, Kobayashi H, Omori S, Ono A, Naito T, Murakami H, Notsu A, Mori K, Harada H, Endo M, Ohde Y, Takahashi K, Takahashi T. Proposing synchronous oligometastatic non-small-cell lung cancer based on progression after first-line systemic therapy. Cancer Sci 2020; 112:359-368. [PMID: 33098119 PMCID: PMC7780027 DOI: 10.1111/cas.14707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/17/2020] [Accepted: 10/17/2020] [Indexed: 12/25/2022] Open
Abstract
Despite the importance of accurate disease definitions for effective management and treatment decisions, there is currently no consensus on what constitutes oligometastatic non–small‐cell lung cancer (NSCLC). Predominant patterns of initial progressive disease (PD) after first‐line systemic therapy have been shown to be a substantial basis for local ablative therapy (LAT) for all disease sites in patients with oligometastatic NSCLC, suggesting that these patterns could be helpful in defining synchronous oligometastatic NSCLC. Therefore, this retrospective study aimed to propose a threshold number of metastases for synchronous oligometastatic NSCLC, based on the pattern of initial PD after first‐line systemic therapy. The cut‐off threshold number of metastases compatible with synchronous oligometastatic NSCLC was determined using receiver operating characteristic (ROC) curve analyses of PD at the initially involved sites alone. ROC analysis of 175 patients revealed that the presence of 1‐3 metastases before first‐line treatment (sensitivity, 85.9%; specificity, 97.3%; area under the curve, 0.91) was compatible with oligometastatic NSCLC, therefore we divided patients into oligometastatic NSCLC and non‐oligometastatic NSCLC groups. Multivariate logistic regression analyses revealed oligometastatic NSCLC to be the only independent predictor of PD at initially involved sites alone (odds ratio 165.7; P < .001). The median survival times in patients with oligometastatic or non‐oligometastatic NSCLC were 23.0 and 10.9 mo (hazard ratio, 0.51; P = .002), respectively. Based on these findings, we propose synchronous oligometastatic NSCLC as 1‐3 metastases in accordance with patterns of initial progression. The result of our study might be contributory to provide a common definition of synchronous oligometastatic NSCLC.
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Affiliation(s)
- Taichi Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.,Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Eriko Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Nobuaki Mamesaya
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shota Omori
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akifumi Notsu
- Department of Biostatistics, Shizuoka Cancer Center, Shizuoka, Japan
| | - Keita Mori
- Department of Biostatistics, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideyuki Harada
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masahiro Endo
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yasuhisa Ohde
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Imazio M. Pericardiocentesis With Extended Drainage and Colchicine: New Indication for Malignant Pericardial Effusions? J Am Coll Cardiol 2020; 76:1562-1563. [PMID: 32972533 PMCID: PMC7505569 DOI: 10.1016/j.jacc.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Massimo Imazio
- University Cardiology, AOU Città della Salute e della Scienza di Torino, Torino, Italy.
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Chai CM, Seier K, Tan KS, Chu I, Isbell JM, Fischer GW, Afonso AM. Pericardial Effusions in Patients With Cancer: Anesthetic Management and Survival Outcomes. J Cardiothorac Vasc Anesth 2020; 35:571-577. [PMID: 32967792 DOI: 10.1053/j.jvca.2020.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The objective of this study was to describe practice patterns of anesthetic management during pericardial window creation. DESIGN Retrospective observational cohort study. SETTING Single tertiary cancer center. PARTICIPANTS A total of 150 patients treated for cancer between 2011 and 2015 were included in the study. MEASUREMENTS AND MAIN RESULTS The primary objective was to evaluate anesthetic management in pericardial window creation. Secondary outcomes were 30-day mortality and overall survival after pericardial window creation. Thirty-day mortality was 19.3%, and median survival was 5.84 months. Higher American Society of Anesthesiologists (ASA) physical status of patients was associated with preinduction arterial line placement (51% ASA 3 v 79% ASA 4; p = 0.002) and use of etomidate for anesthetic induction (34% ASA 3 v 60% ASA 4; p = 0.003). However, there was no association between anesthetic management and presence of tamponade in these patients. Cardiac aspirate volume (per 10 mL: odds ratio [OR], 1.02 [95% CI, 1.0-1.04]; p = 0.026) and intraoperative arrhythmia (atrial fibrillation: OR, 6.76 [95% CI, 1.2-37.49]; p = 0.029; sinus tachycardia: OR, 4.59 [95% CI, 1.25-16.90]; p = 0.022) were associated independently with increased 30-day mortality. High initial heart rate (per 10 beats per minute: hazard ratio [HR], 1.18 [95% CI, 1.05-1.33]; p = 0.005) in the operating room and intraoperative sinus tachycardia (HR, 1.86 [95% CI, 1.15-3.03]; p = 0.012) were associated independently with worse overall survival. CONCLUSION Risk of death after pericardial window creation remains high in patients with cancer. Variations in anesthetic management did not affect survival in oncologic patients with pericardial effusions.
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Affiliation(s)
- Casey M Chai
- Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY
| | - Kenneth Seier
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Iris Chu
- Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY
| | - James M Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gregory W Fischer
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anoushka M Afonso
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
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Moursy S, Gaballa S, Ahmed A, Hlaing KM, Patel BB. Impending Cardiac Tamponade as the Initial Manifestation of BCR-ABL Positive Chronic Myeloid Leukemia. Cureus 2020; 12:e9631. [PMID: 32923232 PMCID: PMC7478927 DOI: 10.7759/cureus.9631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Leukemia involves all organs and tissues of the body. Leukemic infiltration of the pericardium has been documented frequently at post-mortem examinations. Clinically, however, pericardial effusion with cardiac tamponade is rare, and only isolated case reports have been described. In all the reported cases, therapeutic pericardiocentesis was required for the relief of cardiac tamponade with the risk of bleeding since these patients often had deranged hemostasis. We are reporting a rare case of hemorrhagic pericardial effusion in chronic myeloid leukemia before starting the tyrosine kinase inhibitors. The patient required therapeutic pericardiocentesis and hydroxyurea treatment.
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Affiliation(s)
- Safa Moursy
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Salem Gaballa
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | | | - Kyaw M Hlaing
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Brijesh B Patel
- Internal Medicine/Pulmonary and Critical Care, LewisGale Medical Center, Salem, USA
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35
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Donisan T, Balanescu DV, Palaskas N, Lopez-Mattei J, Karimzad K, Kim P, Charitakis K, Cilingiroglu M, Marmagkiolis K, Iliescu C. Cardiac Interventional Procedures in Cardio-Oncology Patients. Cardiol Clin 2020; 37:469-486. [PMID: 31587788 DOI: 10.1016/j.ccl.2019.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Comorbidities specific to the cardio-oncology population contribute to the challenges in the interventional management of patients with cancer and cardiovascular disease (CVD). Patients with cancer have generally been excluded from cardiovascular randomized clinical trials. Endovascular procedures may represent a valid option in patients with cancer with a range of CVDs because of their minimally invasive nature. Patients with cancer are less likely to be treated according to societal guidelines because of perceived high risk. This article presents the specific challenges that interventional cardiologists face when caring for patients with cancer and the modern tools to optimize care.
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Affiliation(s)
- Teodora Donisan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA. https://twitter.com/TDonisan
| | - Dinu Valentin Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA. https://twitter.com/dinubalanescu
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA
| | - Kaveh Karimzad
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA
| | - Peter Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA
| | - Konstantinos Charitakis
- Department of Cardiology, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USA
| | - Mehmet Cilingiroglu
- Department of Cardiology, Arkansas Heart Hospital, 1701 South Shackleford Road, Little Rock, AR 72211, USA
| | | | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA.
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36
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Imazio M, Colopi M, De Ferrari GM. Pericardial diseases in patients with cancer: contemporary prevalence, management and outcomes. Heart 2020; 106:569-574. [PMID: 31980441 DOI: 10.1136/heartjnl-2019-315852] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/07/2019] [Accepted: 11/29/2019] [Indexed: 11/04/2022] Open
Abstract
Neoplastic pericardial effusion is a common and serious manifestation of advanced malignancies. Lung and breast carcinoma, haematological malignancies, and gastrointestinal cancer are the most common types of cancer involving the pericardium. Pericardial involvement in neoplasia may arise from several different pathophysiological mechanisms and may be manifested by pericardial effusion with or without tamponade, effusive-constrictive pericarditis and constrictive pericarditis. Management of these patients is a complex multidisciplinary problem, affected by clinical status and prognosis of patients.
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Affiliation(s)
- Massimo Imazio
- University Cardiology, AOU Città della Salute e della Scienza di Torino, Torino, Piemonte, Italy .,Department of Medical Sciences, University of Turin, Torino, Piemonte, Italy
| | - Marzia Colopi
- University Cardiology, AOU Città della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | - Gaetano Maria De Ferrari
- University Cardiology, AOU Città della Salute e della Scienza di Torino, Torino, Piemonte, Italy
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37
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Lutz A, Schelbert EB, Lontos K, Rossetti J, Katz W. Acute Myeloid Leukemia Presenting as Effusive Constrictive Pericarditis. ACTA ACUST UNITED AC 2019; 4:97-102. [PMID: 32337400 PMCID: PMC7175754 DOI: 10.1016/j.case.2019.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AML infrequently causes tamponade and effusive constrictive pericarditis. Pericardial cytology has limited sensitivity for malignancy. Imaging identifies pericardial effusion and confirms tamponade and constriction.
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Affiliation(s)
- Andrew Lutz
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Erik B Schelbert
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Konstantinos Lontos
- Department of Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - James Rossetti
- Department of Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - William Katz
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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38
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Liu G, Zhang Q, Li Z, Chen X, Zhang N, Zhang J. Endometrial carcinoma complicated by malignant pericardial effusion: A case report on the therapeutic regimen. Medicine (Baltimore) 2019; 98:e17584. [PMID: 31626128 PMCID: PMC6824758 DOI: 10.1097/md.0000000000017584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
RATIONALE High-stage endometrial carcinoma is an aggressive tumor with a high propensity for distant spread. However, metastases to the pericardium are rare in gynecological cancer, and are usually fatal. PATIENT CONCERNS A 69-year-old woman was diagnosed with endometrial carcinoma with pericardium metastasis. The symptoms at presentation were panic and shortness of breath. DIAGNOSES The cytologic examination of pericardial fluid obtained by pericardiocentesis confirmed metastasis. INTERVENTIONS In addition to cisplatin instilled into the pericardial space, for systemic chemotherapy, we chose that gemcitabine and lobaplatin regimen be preferred. OUTCOMES The patient has been participating in telephone follow-up for 8 months and has generally remained in a good condition. LESSONS Endometrial carcinoma can have pericardial metastases. When this happens, we recommend ultrasound-guided pericardial puncture and the pericardial injection of cisplatin, in combination with systemic chemotherapy that consists of gemcitabine and lobaplatin.
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Affiliation(s)
- Guang Liu
- Department of Cardiology, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital
| | | | - Ze Li
- Department of Emergency, Hebei Medical University Second Affiliated Hospital, Shijiazhuang, Hebei, P. R. China
| | | | - Ning Zhang
- Department of Cardiology, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital
| | - Jinli Zhang
- Department of Cardiology, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital
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39
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Kotake M, Imai H, Kaira K, Fujisawa T, Yanagita Y, Minato K. Intrapericardial carboplatin in the management of malignant pericardial effusion in breast cancer: a pilot study. Cancer Chemother Pharmacol 2019; 84:655-660. [PMID: 31250155 PMCID: PMC6682572 DOI: 10.1007/s00280-019-03897-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/15/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Malignant pericarditis is observed in 5.1-7.0% of all cases of acute pericarditis, and malignant pericardial effusion (MPE) can lead to cardiac tamponade in the later stages of cancer. Breast cancer is the second most common primary cancer associated with MPE, but the efficacy and safety of intrapericardial carboplatin (CBDCA) have never been evaluated in breast cancer. In this study, we assessed the clinical significance of intrapericardial CBDCA following catheter drainage in patients with breast cancer-related MPE. METHODS A catheter was inserted percutaneously into the pericardial space under echocardiographic guidance. After complete drainage, 150 mg of CBDCA was instilled into the pericardial space through the catheter. RESULTS Eight patients with symptomatic breast cancer-related MPE were treated at the Gunma Prefectural Cancer Center, between July 2010 and March 2016. One month after treatment, 100% of MPE was controlled. The median survival time from the recurrence of breast cancer until death or study follow-up was 2336 days (range 293-3937 days), while that from intrapericardial CBDCA administration until death or study follow-up was 552 days (range 35-1673 days). Grade 1 fever, nausea, hypotension, fatigue, and chest discomfort were observed in one patient (12.5%) after intrapericardial CBDCA administration. CONCLUSIONS We found that intrapericardial administration of CBDCA after catheter drainage appears to be safe and effective in managing breast cancer-associated MPE. As the number of patients in this study was small, further studies are warranted to determine the safety and efficacy of intrapericardial CBDCA in the management of breast cancer-related MPE.
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Affiliation(s)
- Mie Kotake
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1, Takahayashinishi, Ota, Gunma, 373-8550, Japan.
| | - Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1, Takahayashinishi, Ota, Gunma, 373-8550, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Tomomi Fujisawa
- Division of Breast Oncology, Gunma Prefectural Cancer Center, Ota, Japan
| | - Yasuhiro Yanagita
- Division of Breast Oncology, Gunma Prefectural Cancer Center, Ota, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1, Takahayashinishi, Ota, Gunma, 373-8550, Japan
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40
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Carasso S, Grosman-Rimon L, Nassar A, Kusniec F, Ghanim D, Elbaz-Greener G, Kinany W, Sudarsky D, Hazanov E, Amir O. Serum BNP levels are associated with malignant pericardial effusion. IJC HEART & VASCULATURE 2019; 23:100359. [PMID: 31008182 PMCID: PMC6458500 DOI: 10.1016/j.ijcha.2019.100359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 11/30/2022]
Abstract
Introduction The development of malignant pericardial effusion indicates a poor prognosis and is the leading cause of cardiac tamponade. The objectives of the study were to examine the levels of BNP in traumatic, malignant and non-malignant pericardial effusion etiologies, and to assess the value of serum and pericardial fluid BNP levels in the prognosis of malignant pericardial effusion. Methods A of 56 patients with clinical and echocardiographic diagnosis of pre-tamponade or tamponade who required pericardiocentesis were included in the study. BNP levels were assessed in the serum and within the pericardial fluid. The diagnostic value of BNP levels in discriminating between malignant and non- malignant etiology of pericardial effusion was examined using a receiver-operating characteristic (ROC). Results Pericardial fluid BNP levels were similar across all etiology groups. In patients with malignant etiology, the amount of pericardial fluid was high and their serum BNP levels were relatively low. BNP levels were strong predictors of malignant pericardial effusion, and the cut-off point of BNP ≤ 250 pg/ml demonstrated the highest sensitivity (90.0%) for malignant etiology. Conclusions Low serum BNP levels were significantly associated with malignancy in patients undergoing pericardiocentesis for pericardial effusions. Serum BNP levels <250 pg/ml may trigger more extensive diagnostic testing for malignant pericardial effusion in patients with small pericardial effusion who are not considered for pericardiocentesis due to small effusion, in whom the etiology is unclear.
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Affiliation(s)
- Shemy Carasso
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Liza Grosman-Rimon
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Ali Nassar
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel
| | - Fabio Kusniec
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Diab Ghanim
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Gabby Elbaz-Greener
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Wadi Kinany
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Doron Sudarsky
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel
| | - Evgeni Hazanov
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel
| | - Offer Amir
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
- Corresponding author at: Cardiovascular Institute, Baruch Padeh Medical Center, Poriya, Tiberias, Israel & The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel.
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Pabba K, Rojas-Hernandez CM. Concurrent presentation of a hemorrhagic pericardial effusion and venous thromboembolism in malignancy: a systematic review of case studies. J Thromb Thrombolysis 2019; 48:454-458. [PMID: 31134447 DOI: 10.1007/s11239-019-01884-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The concurrent presentation of symptomatic malignant pericardial hemorrhage and venous thromboembolism is a rare event that poses a clinical dilemma. Existing VTE guidelines do not indicate when, or if, anticoagulation therapy should be started after the treatment of the pericardial bleed. We performed a systematic review to compile the published clinical evidence on the occurrence of coexisting pericardial hemorrhage and VTE in cancer patients and to describe the clinical presentations and bleeding and thrombosis outcomes before and after anticoagulation therapy. We studied published case reports on patients with cancer who presented to the hospital with pericardial hemorrhage and VTE through April 11, 2019. We found seven published case reports. All patients had suffered from a pulmonary embolism and had pericardiocentesis during hospitalization. Five patients (71%) had lung cancer. Four patients (57%) were started on anticoagulation after pericardial drainage and survived the index event. Two patients (29%) were not started on anticoagulation after pericardiocentesis; only one of these patients survived the hospitalization. Pericardial bleeding risk in cancer may be inherent to malignancy, and it is unclear if anticoagulation use increases the risk of recurrent pericardial bleeding. The management of pericardial bleeding typically requires pericardiocentesis, and clinical registries, prospective collaboration projects, and case adjudication are needed to establish the safety of initiation of antithrombotic therapy in such patients.
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Affiliation(s)
- Krishna Pabba
- Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Cristhiam M Rojas-Hernandez
- Section of Benign Hematology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Suite 1464, Houston, TX, 77030, USA.
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42
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Prognostic factors and nomogram for cancer-specific death in non small cell lung cancer with malignant pericardial effusion. PLoS One 2019; 14:e0217007. [PMID: 31095610 PMCID: PMC6521987 DOI: 10.1371/journal.pone.0217007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/02/2019] [Indexed: 01/21/2023] Open
Abstract
Background The prognosis of lung cancer with malignant pericardial effusion is very terrible owing to the impact of cardiac tamponade. The aim of our study seeks to identify prognostic factors and establish a prognostic nomogram of non small cell lung cancer (NSCLC) with malignant pericardial effusion. Methods NSCLC patients with malignant pericardial effusion between 2010 and 2014 are searched from SEER database.Cancer-specific death of these patients are analyzed through the Kaplan–Meier method, Cox proportional hazard model and competing risk model. Prognostic nomogram of cancer-specific death is performed and validated with concordance index (C-index), calibration plots and internal validation population. Propensity score matching is used to evaluate whether chemotherapy affected the survival of study population. Results 696 eligible NSCLC patients are involved in the study population, with 22.7% of 1-year survival rate and 8.9% of 2-year survival rate. Laterality, AJCC N, AJCC T, and chemotherapy are regarded as independent prognostic factors of cancer-specific death in the Cox proportional hazards model and competing risk model. The C-index of established nomogram is 0.703(95%CI:0.68–0.73) for cancer-specific death in the study population with acceptable calibration, which is significantly higher than classical TNM stage(C-index = 0.56, 95%CI:0.52–0.60). After 1:1 propensity score matching, chemotherapy potentially reduces the risk of cancer-specific death (HR = 0.42 95%CI: 0.31–0.58) of NSCLC with pericardial effusion. Conclusions NSCLC with malignant pericardial effusion harbors low overall survival. One prognostic nomogram based on laterality, AJCC N, AJCC T and chemotherapy is developed for cancer-specific death to predict 1-year and 2-year survival rate with good performance.
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Dracham CB, Gupta S, Das CK, Elangovan A. Platinum sensitive carcinoma of ovary relapsed as pericardial effusion with cardiac tamponade. BMJ Case Rep 2019; 12:12/3/e228268. [PMID: 30904894 DOI: 10.1136/bcr-2018-228268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Epithelial ovarian cancers typically spread by intraperitoneal exfoliation and retroperitoneal lymph nodal involvement along the ovarian vascular supply. Pericardial involvement in ovarian malignancies is very rare with only few cases reported in the literature. Malignancy is the most common cause for pericardial effusion in the western world. In this case report, we present a 58-year-old woman treated for high-grade serous carcinoma of the ovary in 2010, relapsed with pericardial effusion and cardiac tamponade in 2017. Imaging studies revealed gross pericardial effusion. Two-dimensional echocardiogram showed massive pericardial effusion, with cardiac tamponade, New York Heart Association-IV. Pericardiocentesis and pigtail drain was placed under echo guidance. Immunocytochemistry has confirmed the tumour cells to be of the ovarian origin. The patient underwent surgical pericardial window via thoracotomy, followed by paclitaxel and carboplatin-based chemotherapy and olaparib maintenance.
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Affiliation(s)
- Chinna Babu Dracham
- Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shipra Gupta
- Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chandan Krushna Das
- Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Elangovan
- Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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44
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Di Liso E, Menichetti A, Dieci MV, Ghiotto C, Banzato A, Bianchi A, Pintacuda G, Padovan M, Nappo F, Cumerlato E, Miglietta F, Mioranza E, Zago G, Corti L, Guarneri V, Conte P. Neoplastic Pericardial Effusion: A Monocentric Retrospective Study. J Palliat Med 2019; 22:691-695. [PMID: 30888908 DOI: 10.1089/jpm.2018.0491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Neoplastic pericardial effusion (NPE) is a life-threatening condition that can worsen clinical outcome in cancer patients. The optimal management of NPE has yet to be defined because randomized studies are lacking. Objective: We report a retrospective monoinstitutional experience describing characteristics, management and prognostic factors in NPE patients. Design: We reviewed clinical, pathological, and echocardiographic features, therapeutic strategies, and outcome in NPE patients referred to our institute from August 2011 to December 2017. Measurements: Twenty-nine patients with NPE from solid tumors have been identified: 21 lung, 5 breast, and 3 other cancer patients. Results: Median age was 62 years. Most of the patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2 (69%) and a symptomatic NPE (69%). In 52% of patients NPE was detected at first diagnosis of metastatic disease, and in 20% of patients pericardium was the only site of metastases. Most of the patients (62%) received systemic therapy, 28% received combined locoregional and systemic therapy, and 10% received locoregional therapy alone. Median overall survival (OS) from NPE diagnosis was 3.9 months. Patients with PS ≥2 had worse OS than patients with better PS <2 (hazard ratio [HR] 3.56, IC 95% 1.19-10.65, p 0.02). Older age, extrapericardial disease, and NPE at progression showed a trend of association with worse OS. Patients treated with locoregional therapy alone showed the shortest median OS (p 0.05). Conclusions: NPE is related to dismal prognosis. Poor PS significantly worsens survival and influences therapeutic approaches. Randomized studies are required to investigate prognostic factors and appropriate clinical management for patients with NPE.
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Affiliation(s)
- Elisabetta Di Liso
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Alice Menichetti
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Maria Vittoria Dieci
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy.,2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Cristina Ghiotto
- 2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Alberto Banzato
- 3 Cardiology Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | | | | | - Marta Padovan
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Floriana Nappo
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Enrico Cumerlato
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Federica Miglietta
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Eleonora Mioranza
- 2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Giulia Zago
- 2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Luigi Corti
- 5 Radiotherapy Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Valentina Guarneri
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy.,2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Pierfranco Conte
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy.,2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
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45
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Kızıltunç E, Ünlü S, Yakıcı İE, Kundi H, Korkmaz A, Çetin M, Örnek E. Clinical characteristics and prognosis of cardiac tamponade patients: 5‑year experience at a tertiary center. Herz 2018; 45:676-683. [PMID: 30470911 DOI: 10.1007/s00059-018-4769-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/06/2018] [Accepted: 10/29/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Cardiac tamponade (CT) is characterized by compression of the cardiac chambers due to pericardial fluid accumulation. The etiology and prognosis may vary in different regions, and thus patient series from various regions can be useful for exploring the etiological and prognostic disparities. The aim of this study was to determine the clinical characteristics of patients with imminent CT, to evaluate the diagnostic performance of biochemical, microbiologic, and pathologic laboratory analysis, and to ascertain the prognosis of CT patients. METHODS We enrolled all patients with imminent CT who underwent percutaneous pericardiocentesis between July 2012 and December 2017 in this retrospective study. The patients were classified into three etiology groups: (a) malignancy (MRCT); (b) iatrogenic/mechanical complication of myocardial infarction (IMCT); and (c) other causes (OCT). Clinical information, laboratory findings, and survival data were recorded. RESULTS In total, 186 pericardiocentesis procedures were performed on 153 consecutive patients with CT. The median follow-up was 137 days (range: 1-1937). The MRCT group had the highest mortality rate (79%) in 12 months, while the OCT group had the lowest rate (27%). We determined that increased age, higher serum urea levels, and malignancy-related CT were independent predictors of mortality. The mortality rates of the MRCT and IMCT groups were similar, with both of them being significantly higher than the rate of the OCT group. In all, 15 patients were diagnosed with a new malignancy via pericardial fluid cytology. CONCLUSION Patients in the MRCT and IMCT groups had a poor prognosis. The presence of malignancy was found to be the most powerful predictor of mortality in CT patients.
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Affiliation(s)
- E Kızıltunç
- Cardiology Department, Numune Education and Research Hospital, 06100, Ankara, Turkey.
| | - S Ünlü
- Cardiology Department, Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - İ E Yakıcı
- Cardiology Department, Numune Education and Research Hospital, 06100, Ankara, Turkey
| | - H Kundi
- Cardiology Department, Numune Education and Research Hospital, 06100, Ankara, Turkey.,Cardiology Department, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - A Korkmaz
- Cardiology Department, Numune Education and Research Hospital, 06100, Ankara, Turkey
| | - M Çetin
- Cardiology Department, Numune Education and Research Hospital, 06100, Ankara, Turkey
| | - E Örnek
- Cardiology Department, Numune Education and Research Hospital, 06100, Ankara, Turkey
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46
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Lekhakul A, Assawakawintip C, Fenstad ER, Pislaru SV, Thaden JJ, Sinak LJ, Kane GC. Safety and Outcome of Percutaneous Drainage of Pericardial Effusions in Patients with Cancer. Am J Cardiol 2018; 122:1091-1094. [PMID: 30064854 DOI: 10.1016/j.amjcard.2018.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 11/26/2022]
Abstract
Malignancy is a common cause of pericardial effusions. The findings, immediate safety and longer-term outcomes of pericardiocentesis are less well defined. We reviewed the cases of all patients with malignancy that underwent pericardiocentesis at our institution over a 10-year period. From January 1, 2007 to December 31, 2016, 171 patients with cancer underwent echo-guided pericardiocentesis. A total of 53% were male with a mean age of 60 ± 15 years. The average volume drained was 485 (IQR 350 to 719) ml. The procedure was technically successful in 170/171 (99.4%) of patients without significant complications; there were no procedure-related deaths. A total of 20% had hemorrhagic, 48% had serosanguinous, and 31% serous pericardial effusions. The type of effusion was not associated with outcome. Cytology (measured in 164) was positive in 58% and only weakly related to outcome (median survival nine versus 18 weeks, p = 0.04). Per our institutional practice, a pericardial catheter was left in place until there were less than 50 ml of net drainage in 24 hours (average 3 ± 2 days). A total of 135 patients had metastatic carcinoma, 23 patients had lymphoma or chronic leukemia and 4 metastatic sarcoma. Patients with either lymphoma or chronic leukemia had better survival than those with carcinoma or sarcoma (median survival 102 vs 12 weeks, p < 0.0001) with a 46% vs 3% 5-year survival, p < 0.0001). Echoguided pericardiocentesis with extended pericardial catheter placement is safe and effective in cancer patients with pericardial effusions. However, overall outcomes are poor in cancer patients with pericardial effusions that required drainage, particularly in those with carcinoma or sarcoma.
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47
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Pericardial and Pleural Metastases: Clinical, Histologic, and Molecular Differences. Ann Thorac Surg 2018; 106:872-879. [DOI: 10.1016/j.athoracsur.2018.04.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 11/22/2022]
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48
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Montañez-Valverde RA, Olarte NI, Zablah G, Hurtado-de-Mendoza D, Colombo R. Swinging heart caused by diffuse large B-cell lymphoma. Oxf Med Case Reports 2018; 2018:omy075. [PMID: 30159160 PMCID: PMC6109201 DOI: 10.1093/omcr/omy075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/13/2018] [Accepted: 07/20/2018] [Indexed: 01/01/2023] Open
Abstract
Pericardial disease is a common complication of solid tumors and occasionally seen in hematologic malignancies. Pericardial effusion, when it occurs, is usually caused by tumor seeding of the pericardium leading to a serous effusion or by mass effect from mediastinal lymphadenopathy blocking drainage of lymphatic ducts. Pericardial disease from non-Hodgkin's lymphoma is uncommon and malignant pericardial effusion is even rarer. Here we present a case of a 31-year-old male with diffuse large B-cell lymphoma who developed cardiac tamponade from a malignant pericardial effusion.
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Affiliation(s)
- Raúl A Montañez-Valverde
- Beth Israel Deaconess Medical Center/Harvard Medical School, Cardiovascular Division, Boston, MA, USA.,Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Neal Ivan Olarte
- University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - Gerardo Zablah
- University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | | | - Rosario Colombo
- Jackson Memorial Hospital, Cardiovascular Division, Miami, FL, USA
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49
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Oyakawa T, Muraoka N, Iida K, Kusuhara M, Naito T, Omae K. Characteristics of cellular composition in malignant pericardial effusion and its association with the clinical course of carcinomatous pericarditis. Jpn J Clin Oncol 2018; 48:291-294. [PMID: 29300912 DOI: 10.1093/jjco/hyx187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/10/2017] [Indexed: 01/22/2023] Open
Abstract
To date, the cellular composition of malignant pericardial effusion (MPE) and its association with the clinical course of carcinomatous pericarditis remain unclear. We aimed to determine the MPE cellular composition and its association with carcinomatous pericarditis. Forty-four cases indicated for pericardial drainage due to symptomatic carcinomatous pericarditis were retrospectively reviewed; the blood cell count and composition of MPE were examined. The most dominant cells in MPE were neutrophils. The appearance ratio of an atypical cell in cytologically positive MPE was 95.5%. Low neutrophil and high lymphocyte counts were significantly associated with good effusion failure-free survival at 1 month. The survival after pericardial drainage was significantly shorter when the neutrophil/lymphocyte ratio was 3.5 or more (P = 0.041). Patients whose performance status improved due to drainage had significantly high leukocyte counts in MPE (P = 0.02). Prediction of the course of drainage through basic examination of MPE cellular composition might be beneficial in clinical practice.
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Affiliation(s)
| | - Nao Muraoka
- Division of Cardiology, Shizuoka Cancer Center
| | - Kei Iida
- Division of Cardiology, Shizuoka Cancer Center
| | | | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center
| | - Katsuhiro Omae
- Clinical Research Promotion Unit, Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
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50
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Gérard D, Thomas B, Lesesve JF. Non-small cell lung carcinoma metastatic cells in a pericardial effusion. Cytopathology 2018; 29:311-312. [PMID: 29714042 DOI: 10.1111/cyt.12545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2018] [Indexed: 11/27/2022]
Affiliation(s)
- D Gérard
- Service d'Hématologie Biologique, University Hospital, Nancy, France
| | - B Thomas
- Service d'Hématologie Biologique, University Hospital, Nancy, France
| | - J-F Lesesve
- Service d'Hématologie Biologique, University Hospital, Nancy, France
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