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Trapé J, Bérgamo S, González-Garcia L, González-Fernández C. Lung cancer tumor markers in serous effusions and other body fluids. Tumour Biol 2024; 46:S99-S110. [PMID: 36502355 DOI: 10.3233/tub-220024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
From its onset and during its progression, lung cancer may affect various extrapulmonary structures. These include the serous membranes, the pleura and pericardium, and less frequently the central nervous system, with leptomeningeal involvement. In these cases, fluid accumulates in the serous membranes which may contain substances secreted by the tumor. Measuring the concentrations of these substances can provide useful information for elucidating the origin of the fluid accumulation, either in pleural and pericardial effusions or in cerebrospinal fluid. This paper describes the histological types of lung cancer that most frequently affect the serosa and leptomeninges. It also reviews the literature on tumor markers in different fluids and makes recommendations for their interpretation.
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Affiliation(s)
- Jaume Trapé
- Department of Laboratory Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
- Tissue Repair and Regeneration Laboratory, Centre for Health and Social Care Research, University of Vic - Central University of Catalonia, Vic, Catalonia, Spain
- Faculty of Medicine, University of Vic - Central University of Catalonia, Vic, Catalonia, Spain
| | - Silvia Bérgamo
- Department of Laboratory Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
- Tissue Repair and Regeneration Laboratory, Centre for Health and Social Care Research, University of Vic - Central University of Catalonia, Vic, Catalonia, Spain
- Doctoral School, University of Vic - Central University of Catalonia, Vic, Catalonia, Spain
| | - Laura González-Garcia
- Department of Laboratory Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
- Tissue Repair and Regeneration Laboratory, Centre for Health and Social Care Research, University of Vic - Central University of Catalonia, Vic, Catalonia, Spain
| | - Carolina González-Fernández
- Department of Laboratory Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
- Gastrointestinal Oncology, Endoscopy and Surgery Research Group, Manresa, Catalonia, Spain
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Mikou P, Pergaris A, Engels M, Chandra A. Review of the impact of the International System for Serous Fluid Cytopathology. Cytopathology 2024; 35:16-22. [PMID: 37795809 DOI: 10.1111/cyt.13313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023]
Abstract
The International System for Reporting Serous Fluid Cytology (TIS) has been proposed by an expert working team composed of the International Academy of Cytology and the American Society of Cytopathology, following an international survey. Since its introduction, the TIS has gained worldwide acceptance, and this review aims to assess its global impact. A literature search revealed 25 studies which have presented data on the impact of the TIS. Most of them provide data, including risk of malignancy (ROM) for each diagnostic category, separately for pleural, peritoneal and pericardial effusions, while a few do not separate them. A few studies focus on specific diagnoses like mesothelioma on specific types of fluids or more specific issues like the optimal fluid volume for cytology or interobserver variability. A synopsis of the data from the literature search is presented in four tables. The ROM assessment is discussed, as well as interobserver variability and the use of ancillary diagnostic immunochemistry. In conclusion, our review of the published data suggests that the TIS is a valid classification scheme that has been widely accepted by pathologists globally, is highly reproducible and makes a valuable contribution to clinical therapeutic management.
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Affiliation(s)
| | - Alexandros Pergaris
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Zeng Y, Wang M, Zhang J, Gao Y. [A case of massive pericardial effusion secondary to esophagojejunostomy anastomotic fistula after total gastrectomy for adenocarcinoma of esophagogastric junction]. Zhonghua Wei Chang Wai Ke Za Zhi 2023; 26:1192-1193. [PMID: 38110282 DOI: 10.3760/cma.j.cn441530-20230411-00112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
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Engels M. [Cytology of body cavity fluids - established methods and new developments]. Pathologe 2022; 43:91-98. [PMID: 34994855 DOI: 10.1007/s00292-021-01042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Body cavity fluids are among the most frequently examined samples in cytology. Cytomorphology is supplemented by additive testing. An international system of terminology and classification has been recently presented. OBJECTIVES Cytopreparation and staining techniques as well as some exemplary morphological patterns are presented. "The International System for Serous Fluid Cytopathology" (TIS) is briefly presented. MATERIALS AND METHODS Pleural effusion, pericardial effusion, and ascites: special technical issues, immunocytochemistry, molecular diagnostics, and reporting system issues are discussed. RESULTS Body cavity fluids are important samples that provide significant information. Additive testing is established for routine use. The form and structure of reports is widely divergent in practical use. DISCUSSION A reporting system for serous fluid cytopathology that is easily applied and recognized internationally is highly desirable. TIS is a valuable approach to this goal.
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Affiliation(s)
- Marianne Engels
- Institut für Pathologie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Deana C, Vetrugno L, Fabris M, Curcio F, Sozio E, Tascini C, Bassi F. Pericardial Cytokine "Storm" in a COVID-19 Patient: the Confirmation of a Hypothesis. Inflammation 2022; 45:1-5. [PMID: 34533672 PMCID: PMC8446479 DOI: 10.1007/s10753-021-01563-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/22/2021] [Accepted: 09/07/2021] [Indexed: 12/30/2022]
Abstract
Novel Coronavirus Disease in most cases produces mild symptoms which resolve after a few days. Some authors hypothesized that SARS-CoV-2 infection could trigger excessive cytokine production leading to a severe multi-organ disease requiring intensive care admission. Respiratory and neurological symptoms are the most frequently reported manifestation of the disease. Indeed, cardiac involvement is reported mostly as a part of a systemic disease. Few isolated cardiac manifestations of COVID-19 infection have been described. We report herein a case of SARS-CoV-2 related severe isolated pericardial involvement requiring ICU admission due to cardiac tamponade needing urgent drainage. Analysis of pericardial fluid from drainage demonstrated a higher cytokine concentration than blood values. Other causes of pericardial disease, such as autoimmunity, bacterial or other than COVID-19 infection, neoplasms or acute myocardial infarction were also evaluated, but all tests confirmed negative results. The suspicion of isolated involvement of the pericardium was therefore demonstrated by the analysis of cytokines which strongly support our hypothesis.
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Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive Care Medicine, Academic Hospital of Udine, Piazzale S.M. della Misericordia, 15, 33100, Udine, Italy.
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care Medicine, Academic Hospital of Udine, Piazzale S.M. della Misericordia, 15, 33100, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Martina Fabris
- Department of Medicine, University of Udine, Udine, Italy
- Institute of Clinical Pathology, Department of Laboratory Medicine, Academic Hospital of Udine, Udine, Italy
| | - Francesco Curcio
- Department of Medicine, University of Udine, Udine, Italy
- Institute of Clinical Pathology, Department of Laboratory Medicine, Academic Hospital of Udine, Udine, Italy
| | - Emanuela Sozio
- Infectious Diseases Clinic, Udine University Hospital, Udine, Italy
| | - Carlo Tascini
- Department of Medicine, University of Udine, Udine, Italy
- Infectious Diseases Clinic, Udine University Hospital, Udine, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care Medicine, Academic Hospital of Udine, Piazzale S.M. della Misericordia, 15, 33100, Udine, Italy
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Carubbi F, Alunno A, Leone S, Di Gregorio N, Mancini B, Viscido A, Del Pinto R, Cicogna S, Grassi D, Ferri C. Pericarditis after SARS-CoV-2 Infection: Another Pebble in the Mosaic of Long COVID? Viruses 2021; 13:v13101997. [PMID: 34696427 PMCID: PMC8540566 DOI: 10.3390/v13101997] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 12/15/2022] Open
Abstract
With the emerging success of the COVID-19 vaccination programs, the incidence of acute COVID-19 will decrease. However, given the high number of people who contracted SARS-CoV-2 infection and recovered, we will be faced with a significant number of patients with persistent symptoms even months after their COVID-19 infection. In this setting, long COVID and its cardiovascular manifestations, including pericarditis, need to become a top priority for healthcare systems as a new chronic disease process. Concerning the relationship between COVID-19 and pericardial diseases, pericarditis appears to be common in the acute infection but rare in the postacute period, while small pericardial effusions may be relatively common in the postacute period of COVID-19. Here, we reported a series of 7 patients developing pericarditis after a median of 20 days from clinical and virological recovery from SARS-CoV-2 infection. We excluded specific identifiable causes of pericarditis, hence we speculate that these cases can be contextualized within the clinical spectrum of long COVID. All our patients were treated with a combination of colchicine and either ASA or NSAIDs, but four of them did not achieve a clinical response. When switched to glucocorticoids, these four patients recovered with no recurrence during drug tapering. Based on this observation and on the latency of pericarditis occurrence (a median of 20 days after a negative nasopharyngeal swab), could be suggested that post-COVID pericarditis may be linked to ongoing inflammation sustained by the persistence of viral nucleic acid without virus replication in the pericardium. Therefore, glucocorticoids may be a suitable treatment option in patients not responding or intolerant to conventional therapy and who require to counteract the pericardial inflammatory component rather than direct an acute viral injury to the pericardial tissue.
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Affiliation(s)
- Francesco Carubbi
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
- Department of Medicine, ASL 1 Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, 67100 L’Aquila, Italy;
- Correspondence:
| | - Alessia Alunno
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
| | - Silvia Leone
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
| | - Nicoletta Di Gregorio
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
- Department of Medicine, ASL 1 Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, 67100 L’Aquila, Italy;
| | - Bernardina Mancini
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
- Department of Medicine, ASL 1 Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, 67100 L’Aquila, Italy;
| | - Angelo Viscido
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
| | - Rita Del Pinto
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
| | - Sabrina Cicogna
- Department of Medicine, ASL 1 Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, 67100 L’Aquila, Italy;
- Cardiology and Coronary Care Unit, San Salvatore Hospital, 67100 L’Aquila, Italy
| | - Davide Grassi
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
| | - Claudio Ferri
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
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Sahu S, Sharma S, Gupta P, Dey P. MOC31 Immunostaining in the Diagnosis of Metastatic Adenocarcinoma in Serous Fluid: Special Emphasis on Atypical Cytological Cases. Acta Cytol 2021; 65:242-249. [PMID: 33827073 DOI: 10.1159/000515173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The diagnosis of atypical cases in the effusion cytology sample often poses a challenge to the cytologists. AIMS AND OBJECTIVES We evaluated the diagnostic role of MOC31 in the metastatic adenocarcinoma in effusion fluid. MATERIALS AND METHODS The cytological examination and MOC31 immunostaining in the cell block sections were carried out in 64 cases of serous effusion. A total of 23 cases showed atypical cytology, out of which suspicious for malignancy (SFM) and atypia of undetermined significance (AUS) were 19 and 4 cases, respectively. In these cases, we also performed calretinin immunostaining. The cytological features, results of MOC31 immunostaining, and follow-up data were correlated to find out the sensitivity and specificity of MOC31 immunostaining in the diagnosis of metastatic adenocarcinoma. RESULT The sensitivity and specificity of MOC31 were 100%. MOC31 detected all the cases of metastatic adenocarcinoma. MOC31 showed strong positivity in 19 cases of SFM. All these cases had a malignant outcome in histopathology or follow-up data. In AUS cases, MOC31 immunostaining was negative with a benign outcome. In all the atypical but malignant cases calretinin stain showed diffuse cytoplasmic and nuclear positivity. In contrast, MOC31 showed strong membranous positivity and occasionally cytoplasmic positivity. CONCLUSION MOC31 is an excellent marker of metastatic adenocarcinoma in the serous effusion. The membranous positivity of MOC31 and negative calretinin immuno-staining are helpful in atypical cytological cases to avoid the diagnostic dilemma. The MOC31 positivity is significantly useful in discrete atypical cells which are more challenging to recognize.
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Affiliation(s)
- Saumya Sahu
- Department of Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shelly Sharma
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Key P, Qiryaqoz Z, Prahlow J, Fisher-Hubbard A. Tuberous Sclerosis Complex Diagnosed After Fatal Aortic Dissection. Am J Forensic Med Pathol 2021; 42:e1-e4. [PMID: 33074837 DOI: 10.1097/paf.0000000000000625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Phillip Key
- From the Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
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Gupta P, Pandey T, Gautam U, Rajwanshi A, Srinivasan R, Gupta N, Rohilla M, Varma N, Dey P. Lymphoreticular malignancies in serous effusions: Cytomorphologic, flow cytometric and immunocytochemical analysis. Diagn Cytopathol 2021; 49:647-656. [PMID: 33629825 DOI: 10.1002/dc.24729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/29/2020] [Accepted: 02/07/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Involvement of body fluids by lymphoreticular malignancies (LRM) is rare and often associated with poor prognosis and decreased overall survival. The present study was conducted to analyze the characteristic cytomorphologic, flow cytometric and immunocytochemical features of LRMs in serous effusions. MATERIALS AND METHODS This was a three-year retrospective study. A total of 218 effusion samples, reported as involved by lymphoreticular malignancies, on cytology, were reviewed. All the cases wherein the cytological diagnosis was confirmed by flow cytometric (FCM) and/or immunocytochemical (ICC) studies were retrieved and studied in detail. FCM and/or ICC were performed in a total of 51/218(23.4%) samples, including 30 pleural (58.8%), 18 peritoneal (35.3%), and 3 pericardial fluid (5.9%) samples. RESULTS The cytomorphologic diagnoses included infiltration by non-Hodgkin lymphoma (NHL;n = 27), infiltration by LRM (n = 19), infiltration by chronic lymphocytic leukemia (CLL;n = 2), Hodgkin's lymphoma (HL;n = 1) and suggestive of infiltration by LRM (n = 2). FCM and/or ICC confirmed the diagnoses as infiltration by T-cell lymphoblastic lymphoma in 18; mature B-cell NHL in 10; Burkitt lymphoma in 7; diffuse large B-cell lymphoma in 4; follicular lymphoma, T- cell NHL and CLL in 2 samples each and hairy cell leukemia, plasmablastic lymphoma and HL in 1 sample each. 94.1% concordance was noted between the initial and final cytologic diagnosis. CONCLUSIONS Involvement of body fluids and effusions by LRMs, though rare, carries an immense prognostic significance and hence the prompt detection is crucial. Detection of these malignancies by cytologic examination of effusions is challenging yet potentially useful and the least invasive method available to establish an early diagnosis.
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Affiliation(s)
- Parikshaa Gupta
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | | | - Upasana Gautam
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Manish Rohilla
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, PGIMER, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
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Blagova O, Varionchik N, Zaidenov V, Savina P, Sarkisova N. Anti-heart antibodies levels and their correlation with clinical symptoms and outcomes in patients with confirmed or suspected diagnosis COVID-19. Eur J Immunol 2021; 51:893-902. [PMID: 33368288 DOI: 10.1002/eji.202048930] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/26/2020] [Accepted: 12/21/2020] [Indexed: 12/28/2022]
Abstract
The aim of this study is to evaluate the blood level of anti-heart antibodies (AHA) and its correlation with clinical outcomes in patients with severe and moderate coronavirus disease 2019 (COVID-19). The study included 34 patients (23 males; mean age 60.2 ± 16.6 years) with COVID-19 pneumonia. Besides standard medical examination, the AHA blood levels were observed, including antinuclear antibodies, antiendothelial cell antibodies, anti-cardiomyocyte antibodies (AbC), anti-smooth muscle antibodies (ASMA), and cardiac conducting tissue antibodies. Median hospital length of stay was 14 [13; 18] days. AHA levels were increased in 25 (73.5%) patients. Significant correlation (p < 0.05) of AHA levels with cardiovascular manifestations (r = 0.459) was found. AbC levels correlated with pneumonia severity (r = 0.472), respiratory failure (r = 0.387), need for invasive ventilation (r = 0.469), chest pain (r = 0.374), low QRS voltage (r = 0.415), and levels of C-reactive protein (r = 0.360) and lactate dehydrogenase (r = 0.360). ASMA levels were found to correlate with atrial fibrillation (r = 0.414, p < 0.05). Antinuclear antibodies and AbC levels correlated with pericardial effusion (r = 0.721 and r = 0.745, respectively, p < 0.05). The lethality rate was 8.8%. AbC and ASMA levels correlated significantly with lethality (r = 0.363 and r = 0.426, respectively, p < 0.05) and were prognostically important. AHA can be considered as part of the systemic immune and inflammatory response in COVID-19. Its possible role in the inflammatory heart disease requires further investigation.
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Affiliation(s)
- Olga Blagova
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Nadezhda Varionchik
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Polina Savina
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Natalia Sarkisova
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
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Jacobi EM, Landon G, Broaddus RR, Roy-Chowdhuri S. Evaluating Mismatch Repair/Microsatellite Instability Status Using Cytology Effusion Specimens to Determine Eligibility for Immunotherapy. Arch Pathol Lab Med 2021; 145:46-54. [PMID: 33367660 PMCID: PMC7529913 DOI: 10.5858/arpa.2019-0398-oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2020] [Indexed: 01/28/2023]
Abstract
CONTEXT.— The approval of pembrolizumab for treatment of patients with microsatellite instability-high (MSI-H) or mismatch repair-deficient (dMMR) advanced cancers has led to increased requests for MSI and/or MMR immunoperoxidase (IPOX) testing. Diagnoses for patients with advanced-stage cancer are frequently made from cytology specimens. OBJECTIVE.— To investigate the feasibility of using cell block (CB) preparations of effusions for MMR IPOX evaluation. DESIGN.— Surgical pathology cases of colorectal and endometrial carcinomas with known MMR/MSI status and matched effusions with available CBs were identified. Cell block sections were evaluated for adequacy and stained with MMR IPOX (MSH2, MSH6, MLH1, and PMS2). The CBs were reviewed, the number of tumor cells quantified, and MMR IPOX was interpreted as retained, lost, suboptimal, or noncontributory. RESULTS.— We identified 748 cases with MMR/MSI testing on surgical specimens having matched effusions. Of these, 131 cases (17.5%) had an available CB and 53 were deemed adequate for MMR IPOX staining. MMR IPOX results between effusion CBs and surgical pathology specimens were concordant in 45 of 53 (85%), inconclusive in 6 of 53 (11%), and discordant in 2 of 53 (4%) cases. CONCLUSIONS.— There was high concordance of MMR IPOX testing between cytologic and surgical specimens, with no false-positive and 2 false-negative CB results. Limited tumor cells, staining in cells indefinite as tumor, tumor staining heterogeneity, and lack of internal control staining were problematic in some cases. Our findings indicate that cytologic effusion specimens may be suitable substrates for MMR IPOX biomarker testing; however, inconclusive cases need to be interpreted with caution.
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Affiliation(s)
- Elizabeth M Jacobi
- The Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston
- Jacobi is currently in the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Gene Landon
- The Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Russell R Broaddus
- The Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston
- Broaddus is currently in the Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill
| | - Sinchita Roy-Chowdhuri
- The Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston
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Abstract
We herein report 3 cases of acute aortic dissection (AAD) in which the initial 12-lead electrocardiogram showed typical ST elevation consistent with acute pericarditis. All patients exhibited small pericardial effusion but did not suffer from rupture into the pericardium or clinical tamponade. Slow leakage or exudate stemming from the dissecting hematoma appeared to have caused inflammation, resulting in pericarditis. Therefore, we highlight the fact that AAD may masquerade as acute pericarditis. Physicians should be aware of the possibility of type A AAD as an important underlying condition, since the early diagnosis and subsequent surgical treatment may save patients' lives.
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Affiliation(s)
| | | | | | | | - Minoru Wake
- Division of Cardiology, Okinawa Chubu Hospital, Japan
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Moady G, Daud E, Galilee R, Sabo E, Mazareb S, Atar S. Pericardial Effusion in a Young Man: A Rare Presentation of Thymoma. Isr Med Assoc J 2020; 22:328-329. [PMID: 32378828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Gassan Moady
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Elias Daud
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
| | - Ronen Galilee
- Department of Thoracic Surgery, Carmel Medical Center, Haifa, Israel
| | - Edmond Sabo
- Department of Pathology, Carmel Medical Center, Haifa, Israel
| | - Salam Mazareb
- Department of Pathology, Carmel Medical Center, Haifa, Israel
| | - Shaul Atar
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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Itagaki H, Yamamoto T, Uto K, Hiroi A, Onizuka H, Arashi H, Shibahashi E, Isomura S, Oda H, Yamashita T, Nagashima Y. Recurrent pericardial effusion with pericardial amyloid deposition: a case report and literature review. Cardiovasc Pathol 2019; 46:107191. [PMID: 31927216 DOI: 10.1016/j.carpath.2019.107191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 11/19/2022] Open
Abstract
Pericardial amyloidosis is a rare cause of pericardial effusion. Here, we report a case of recurrent pericardial effusion because of pericardial amyloid deposition. The patient was a man in his 40s admitted for pulmonary embolism. During hospitalization, arterial fibrillation and cardiac tamponade were observed, and an initial pericardial puncture was performed. Thereafter, pericardial puncture was repeated nine times over the next two years. Cytological examination of the pericardial effusion suggested malignant mesothelioma. Afterward, pericardial fenestration and partial resection were performed. Intraoperatively, a thickened pericardium and hemorrhagic pericardial effusion were noted. Histologically, the surface of the pericardium was covered by an eosinophilic amorphous material. Congo red and DYLON stains, electron microscopy, and immunohistochemical findings revealed localized amyloidosis composed of an immunoglobulin lambda light chain. Although the patient did not receive further treatment for 5 years postoperatively, his renal and cardiac functions remained within normal limits. Based on these findings, the patient was diagnosed with localized amyloidosis. So far, hemorrhagic pericardial effusion has been reported in few cases with systemic amyloidosis. Because localized immunoglobulin light-chain-derived (AL) amyloidosis may progress to systemic disease (although it is a very rare occurrence), long-term follow-up is necessary to detect recurrence or progression to a systemic form.
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Affiliation(s)
- Hiroko Itagaki
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan; Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Tomoko Yamamoto
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan; Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenta Uto
- Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan; Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsuko Hiroi
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan; Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiromi Onizuka
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Arashi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Eiji Shibahashi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shogo Isomura
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideaki Oda
- Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Taro Yamashita
- Diagnostic Unit for Amyloidosis, Department of Neurology, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan
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15
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Duran-Moreno J, Kampoli K, Kapetanakis EI, Mademli M, Koufopoulos N, Foukas PG, Kostopanagiotou K, Tomos P, Koumarianou A. Pericardial Synovial Sarcoma: Case Report, Literature Review and Pooled Analysis. In Vivo 2019; 33:1531-1538. [PMID: 31471401 PMCID: PMC6754991 DOI: 10.21873/invivo.11633] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/01/2019] [Accepted: 07/08/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pericardial synovial sarcomas (PSS) are very rare tumors, with dismal prognosis and limited data. We describe the clinical features and identify prognostic factors of primary PSS. CASE REPORT We describe the case of a 56-year-old male patient with PSS managed by the multidisciplinary team of thoracic oncology. The therapeutic plan comprised surgery, chemotherapy, stereotactic radiosurgery and targeted therapy, with excellent results. MATERIALS AND METHODS Data from 37 cases reported in English during the past 20 years were gathered and analyzed. PSS was found to occur at a mean age of 36±17.082 (range=13-67) years. Survival analysis was performed on 20 cases with follow-up of at least 6 months. CONCLUSION Only complete resection of the tumor seems to be an independent prognostic factor. To our knowledge, this is the first report on the safety and effectivity of pazopanib in PSS and may provide guidance for similar cases in the future.
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Affiliation(s)
- Jose Duran-Moreno
- Hematology Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Kampoli
- Hematology Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil I Kapetanakis
- Department of Thoracic Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Mademli
- Second Department of Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nektarios Koufopoulos
- Second Department of Pathology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Periklis G Foukas
- Second Department of Pathology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas Kostopanagiotou
- Department of Thoracic Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Periklis Tomos
- Department of Thoracic Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Koumarianou
- Hematology Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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16
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Seo CG, Kim KJ, Park E, Kim NH, Kim JH, Kim HY, Kim SG, Kim KJ. Untreated primary hypothyroidism with simultaneous rhabdomyolysis, pericardial effusion, and sudden sensorineural hearing loss: a case report. BMC Endocr Disord 2019; 19:52. [PMID: 31113413 PMCID: PMC6530099 DOI: 10.1186/s12902-019-0379-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypothyroidism, one of the prevalent endocrine disorders worldwide, has a broad spectrum of clinical manifestations, from an asymptomatic condition to myxedema coma. Although the majority of patients with hypothyroidism have minor clinical symptoms, which are recovered with levothyroxine treatment, some patients occasionally do experience fatal complications. Here we report, for the first time, the case of a patient who had hypothyroidism with simultaneous occurrence of rhabdomyolysis with acute kidney injury, moderate pericardial effusion, and sudden sensorineural hearing loss. CASE PRESENTATION A 57-year-old man with a previous history of dyslipidemia and untreated hypothyroidism was admitted to the hospital due to shortness of breath, lethargy, lower extremity discomfort, and unilateral hearing loss. Laboratory results revealed rhabdomyolysis with acute kidney injury and severe hypothyroidism. We detected cardiomegaly without lung parenchymal infiltration on chest radiography and moderate pericardial effusion on transthoracic echocardiography. We performed pure tone audiometry and identified profound unilateral sensorineural hearing loss. Aggressive fluid resuscitation, levothyroxine treatment, and systemic and intratympanic steroid therapy alleviated the patient's severe hypothyroidism, rhabdomyolysis, and pericardial effusion; however, sensorineural hearing loss was not fully recovered. CONCLUSIONS Early recognition of life-threatening complications is important in patients with severe hypothyroidism to prevent adverse outcomes. This case suggests that hypothyroidism should be considered in patients who have rhabdomyolysis with acute kidney disease and pericardial effusion. Moreover, sudden sensorineural hearing loss should be kept in mind as a rare complication of hypothyroidism.
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Affiliation(s)
- Chung Gyo Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
| | - Kyoung Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
| | - Euyhyun Park
- Department of Otolaryngology-Head and Neck Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
| | - Joo Hyung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
| | - Hee Young Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
| | - Kyeong Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
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17
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Fallek Boldes O, Dahan S, Segal Y, Ben-Ami Shor D, Huber RK, Barshack I, Horowitz Y, Segal G, Dagan A. Characteristics of Pericardial Biopsy: 100 Cases in a Single Center. Isr Med Assoc J 2019; 21:183-188. [PMID: 30905104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Pericardial biopsies are rarely performed during the diagnosis and management of pericardial diseases. The circumstances and clinical profile of patients undergoing pericardial biopsies are largely uncharacterized. OBJECTIVES To examine the circumstances in which pericardial biopsies are obtained and to evaluate their diagnostic yield. METHODS We studied a total of 100 cases (71% males, mean age 60.8 years, range 8.1-84.5 years) of surgically resected pericardium specimens obtained from 2000 to 2015 at Sheba Medical Center, the largest medical center in Israel. Patients were classified into groups according to four major histological etiologies: idiopathic pericarditis, constrictive pericarditis, malignant pericarditis, and post-cardiac injury syndrome (PCIS). The clinical history and course, laboratory, echocardiography, and histological results were reviewed retrospectively. RESULTS Causes of pericarditis according to histological definitions included idiopathic pericarditis (29%), constrictive pericarditis (29%), PCIS (9%), and malignant pericarditis (26%). Overall sensitivity of the pericardial biopsy in patients with malignancy was 57.7%. During the study period, we found a trend toward an increased number of biopsies due to constrictive pericarditis and PCIS, along with a decrease in the number of biopsies performed in patients with malignant or idiopathic pericarditis. The diagnosis following biopsy did not change for any of the patients. CONCLUSIONS Our findings suggest a low diagnostic yield from pericardial biopsies, especially in malignant pericarditis. This conclusion, along with novel therapies, resulted in the infrequent use of pericardial biopsy in recent years.
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Affiliation(s)
| | - Shani Dahan
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Department of Medicine B, Assuta Ashdod Medical Center, Ashdod, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yahel Segal
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Dana Ben-Ami Shor
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert K Huber
- Institute of Pathology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Barshack
- Institute of Pathology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Horowitz
- Department of Medicine B, Assuta Ashdod Medical Center, Ashdod, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gad Segal
- Department of Internal Medicine T, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Dagan
- Department of Medicine B, Assuta Ashdod Medical Center, Ashdod, Israel
- Department of Rheumatology Unit, Assuta Ashdod Medical Center, Ashdod, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
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18
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Abstract
The authors used scanning electron microscopy (SEM) to examine the cells obtained from serous effusions of patients affected with a neoplasm or benign disease. Cellular morphology was studied in non-neoplastic effusions to distinguish benign cells from cancer cells with which they are almost always suspended in malignant effusions. Tumor cells differ in some features such as shape, size, arrangement and especially in surface structures (microvilli), the latter being very noticeable when using this method. The investigation enabled us to note several changes in the cell surface that could reflect particular activities of the cells themselves. For this reason we believe that the technique may be considered very useful to gain knowledge of cellular morphology. However, it cannot be considered suitable for making routine diagnostic conclusions.
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19
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Meduri A, Di Molfetta DV, Natale L, Manfredi R. Cardiac magnetic resonance in systemic sclerosis patients with cardiac symptoms. Eur Rev Med Pharmacol Sci 2017; 21:4797-4803. [PMID: 29164584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is characterized by widespread vascular lesions and skin and internal organs fibrosis, including the heart; all cardiac layers, endocardium, myocardium, and pericardium, may be involved. We report the relevance of cardiac MRI findings in scleroderma patients with cardiac symptoms. PATIENTS AND METHODS 50 patients, all fulfilling the ACR SSc criteria (19 with limited and 31 with diffused skin involvement) were evaluated using a 1.5T MR scanner. Images were acquired before and after contrast medium administration; the exams were considered positive with one or more of these findings: enlarged volumes, reduced EF, regional kinetic anomalies, edema, DE or pericardial effusion. RESULTS 40 patients (80%) had one or more cardiac abnormalities: 5 patients had myocardial edema; 2 an increased interventricular septum thickness; 22 dilated ventricles or reduced EF; 12 an abnormal regional ventricular motion (2 of these with akinetic segments); 17 a delayed enhancement with different patterns, all without coronary distribution; 22 a pericardial effusion CONCLUSIONS: Pathologic findings were documented in 80% of the cases confirming a high occurrence of abnormal MR data. Myocardial involvement in systemic sclerosis can be assumed by the presence of multiple pathologic MRI findings. CMR seems to be a valuable tool to identify and assess the presence of cardiac involvement.
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Affiliation(s)
- A Meduri
- Department of Bioimages and Radiological Sciences, Catholic University of the Sacred Heart, Agostino Gemelli Polyclinic Foundation, School of Medicine, Rome, Italy.
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20
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Kalogeraki A, Lazopoulos G, Papadakis GZ, Tamiolakis D, Karvela-Kalogeraki I, Karvelas-Kalogerakis M, Segredakis J, Chalkiadakis GE. Cytology of Pericardial Effusion due to Malignancy. ACTA ACUST UNITED AC 2017; 54:179-183. [PMID: 27658166 DOI: 10.1515/rjim-2016-0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Malignant pericardial effusion occurs in one tenth of all cancers. It is a very serious disorder that is mainly a secondary process due to metastasis because primary neoplasms of the pericardium such as mesotheliomas, sarcomas being exceedingly rare [corrected]. Pericardial effusion specimens are uncommon and to the best of our knowledge the current study is the largest systematic evaluation of pericardial fluid cytology performed to date. MATERIAL AND METHODS Pericardial effusion specimens from 145 patients collected over a 25 [corrected] year period were studied by cytology [corrected]. The minimum pericardial fluid volume used for adequate cytologic diagnosis in these patients was more than 60 mL. RESULTS Cytological diagnosis revealed malignant pericardial exudates in 100% of the studied patients [corrected]. CONCLUSIONS Cytology provides an immediate and accurate means of diagnosis. Immunocytology is very important
in the diagnostic evaluation.
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21
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Krumm P, Mueller KAL, Klingel K, Kramer U, Horger MS, Zitzelsberger T, Kandolf R, Gawaz M, Nikolaou K, Klumpp BD, Henes JC. Cardiovascular magnetic resonance patterns of biopsy proven cardiac involvement in systemic sclerosis. J Cardiovasc Magn Reson 2016; 18:70. [PMID: 27765061 PMCID: PMC5073418 DOI: 10.1186/s12968-016-0289-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 09/30/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND To determine morphological and functional cardiovascular magnetic resonance (CMR) patterns in histopathologically confirmed myocardial involvement in patients with systemic sclerosis (SSc). METHODS Twenty patients (6 females; mean age 41 ± 11 years) with histopathologically proven cardiac involvement in SSc in the years 2008-2016 were retrospectively evaluated. Morphological, functional and late gadolinium enhancement (LGE) images were acquired in standard angulations at 1.5 T CMR. Pathologies were categorized: 1) Pericardial effusion; 2) pathologic left (LV) or right ventricular (RV) contractility (hypokinesia, dyssynchrony, and diastolic restriction); 3) reduced left (LV-EF) and right ventricular ejection fraction (RV-EF); 4) fibrosis and/or inflammation (positive LGE); 5) RV dilatation. 95 % confidence intervals (CI) were calculated for appearance of pathologic EF and RV dilatation. RESULTS Seven patients (35 %) had positive CMR findings in three categories, 9 patients (45 %) in four categories and 4 patients (20 %) in five categories. The distribution of pathologic findings was: minimal pericardial effusion in 7 patients (35 %), moderate pericardial effusion >5 mm in nine patients (45 %); abnormal LV or RV contractility in 19 patients (95 %), reduced LV or RV function in 14 patients (70 %; 95 % CI: 51-88 %), pathologic LGE in all patients, RV dilatation in 6 patients (30 %; 95 % CI: 15-54 %). CONCLUSIONS CMR diagnosis of myocardial involvement in SSc requires increased attention to subtle findings. Pathologic findings in at least three of five categories indicate myocardial involvement in SSc.
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MESH Headings
- Adult
- Biopsy
- Cardiomyopathies/diagnostic imaging
- Cardiomyopathies/pathology
- Cardiomyopathies/physiopathology
- Contrast Media/administration & dosage
- Female
- Humans
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Myocardial Contraction
- Myocardium/pathology
- Organometallic Compounds/administration & dosage
- Pericardial Effusion/diagnostic imaging
- Pericardial Effusion/pathology
- Pericardial Effusion/physiopathology
- Predictive Value of Tests
- Retrospective Studies
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/diagnosis
- Stroke Volume
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/pathology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/pathology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
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Affiliation(s)
- Patrick Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076 Germany
| | - Karin A. L. Mueller
- Department of Internal Medicine III, Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany
| | - Karin Klingel
- Department of Pathology and Neuropathology, Molecular Pathology, University of Tübingen, Tübingen, Germany
| | - Ulrich Kramer
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076 Germany
| | - Marius S. Horger
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076 Germany
| | - Tanja Zitzelsberger
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076 Germany
| | - Reinhard Kandolf
- Department of Pathology and Neuropathology, Molecular Pathology, University of Tübingen, Tübingen, Germany
| | - Meinrad Gawaz
- Department of Internal Medicine III, Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076 Germany
| | - Bernhard D. Klumpp
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076 Germany
| | - Joerg C. Henes
- Department of Internal Medicine II, Rheumatology, University of Tübingen, Tübingen, Germany
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Ahmed Wani F, Bhardwaj S. Cytological evaluation and significance of cell cannibalism in effusions and urine cytology. Malays J Pathol 2015; 37:265-270. [PMID: 26712673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cell cannibalism is believed to be an indicator of high-grade aggressive cancers with increased metastatic potential. It denotes both anaplastic grade and invasiveness and is valuable in assessing tumor behavior. The present study was a 2-year retrospective and 1-year prospective study conducted in the Department of Pathology, Government Medical College, Jammu. PAP and MGG stained smears of effusions and urinary cytology were evaluated for cannibalism. Cannibalism was assessed by parameters like cellularity of cannibalism, diameter of cannibalistic cells, chromatin pattern and background of the smears. Of 350 cases evaluated, 260 (74.2%) were benign and 90 (25.8%) were malignant. Cannibalism was absent in all benign cases. Cannibalism was present in 14 ascitic fluids, 7 pleural fluids, 1 pericardial fluid and 3 cases of urine cytology. Comparison of distribution of cannibalism in effusions and urine did not yield statistically significant result (X2=0.8678 and p>0.05). Comparison of other parameters between effusions and urine samples also did not yield significant results. We conclude that cytological parameters of cellular cannibalism are better observed in malignant effusions than in urine cytology but did not reach statistical significance. Cannibalism can be assessed morphologically in malignant body fluids and is an indicator of increased tumour growth.
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Affiliation(s)
- Farooq Ahmed Wani
- Aljouf College of Medicine, Department of Pathology, Sakaka, Saudi Arabia.
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23
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Abstract
A 71-year-old man presented with shortness of breath and tachycardia along with systemic symptoms of weight loss and lethargy. A pulmonary embolus was the initial suspected diagnosis but through extensive investigations a rarer cause of his symptoms was identified. This case demonstrates the importance of cardiac imaging in the assessment and non-invasive tissue characterisation of a suspected cardiac tumour; in our case, this was subsequently confirmed by careful histological/immunocytochemical evaluation of the pericardial effusion as a primary cardiac B-cell non-Hodgkin's lymphoma, thus enabling appropriate management leading to an excellent clinical outcome.
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Affiliation(s)
| | | | | | - Prithwish Banerjee
- Department of Cardiology, University Hospital Coventry & Warwickshire, Coventry, UK
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24
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Ahmed AA, Andraws N, Almutairi AM, Saied HM, Elbagir-Mohamed AM. Cytologic and Immunophenotypic Features of Malignant Cells in Pediatric Body Fluids. Acta Cytol 2015; 59:332-8. [PMID: 26422236 DOI: 10.1159/000440795] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 08/31/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cytospin preparations and immunocytochemistry are common methods in hospitals to evaluate malignancies in body fluids. Characteristics of malignant cells in pediatric body fluids have not been adequately evaluated. STUDY DESIGN 183 pleural, peritoneal and pericardial pediatric fluid specimens were examined by cytospin preparations and immunocytochemistry from two hospitals using similar procedural techniques. Cytologic diagnoses were correlated with the results of clinical history, histology and ancillary studies. RESULTS Forty cases with malignancy were identified (21.9%); the most common diagnoses were rhabdomyosarcoma and acute lymphoblastic lymphoma (9 and 8 cases, respectively). Small round cell tumors revealed similar morphology as clusters of small round cells with central nuclei and scant cytoplasm with frequent small vacuoles. Twenty-one cases were evaluated by immunocytochemistry, 12 by flow cytometry and 5 by cytogenetic analysis. CD3, CD20, TdT, CD10, desmin and myogenin were the most common markers. Staining artifacts causing interpretation difficulties were noted in 5 cases that were resolved by molecular studies and deferral for surgical specimens. CONCLUSIONS Small round cell tumors are the most common malignancies encountered in pediatric body fluids and share a nonspecific morphology. Although immunocytochemistry is helpful to arrive at the correct diagnosis, other ancillary studies may be necessary, particularly in hematologic malignancies and other difficult cases.
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Affiliation(s)
- Atif A Ahmed
- Department of Pathology and Laboratory Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
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25
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Ma GT, Liu JZ, Miao Q, Cui QC. Angiosarcoma of the pericardium: a case report. Int J Clin Exp Pathol 2015; 8:13568-13570. [PMID: 26722576 PMCID: PMC4680521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/25/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Primary malignant tumors of the pericardium are rare, and most primary malignant pericardium tumors are mesotheliomas. Primary pericardial angiosarcoma is extremely rare, and it is associated with a poor prognosis. CASE PRESENTATION We report of a 47-year-old woman who complained of activity-related chest tightness and shortness of breath. Computed tomography, magnetic resonance imaging, and transesophageal echocardiography revealed an enlarged pericardium with hematic and solid components. An exploratory pericardiotomy was performed, and the results of the histological examination were suggestive of spindle cell hemangioendothelioma. She survived for 9 months after surgery without chemotherapy and radiotherapy, and she had a relatively good quality of life. CONCLUSION Primary pericardial angiosarcoma is difficult to diagnose, and it has a poor prognosis. Pericardiotomy, radiation therapy, and chemotherapy were associated with a prolongation of survival.
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Affiliation(s)
- Guo-Tao Ma
- Department of Cardiac Surgery, Peking Union Medical College HospitalBeijing 100730, China
| | - Jian-Zhou Liu
- Department of Cardiac Surgery, Peking Union Medical College HospitalBeijing 100730, China
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College HospitalBeijing 100730, China
| | - Quan-Cai Cui
- Department of Pathology, Peking Union Medical College HospitalBeijing 100730, China
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Kanda H, Moriyama Y, Fukumoto Y, Ueno T, Iwamoto S, Yamashita M, Yotsumoto G, Mukaihara K. [Pericardiectomy of effusive constrictive pericarditis with an ultrasonic scalpel; report of a case]. Kyobu Geka 2015; 68:317-319. [PMID: 25837007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Effusive constrictive pericarditis is a rare clinical entity characterized by concurrent pericardial effusion and visceral pericardial constriction. The most effective therapy for this state is pericardiectomy with complete removal of the parietal and visceral membranes, although the perioperative mortality and morbidity can be high. We presented a case of a 45-year-old man in whom a visceral pericardiectomy with waffle procedure was successfully performed using an ultrasonic scalpel without use of cardiopulmonary bypass. His postoperative course was uneventful and cardiac hemodynamics restored to normal. There were no signs or symptoms of recurrence in 2 years of follow-up.
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Affiliation(s)
- Hideaki Kanda
- Department of Cardiovascular Surgery, Kagoshima Medical Center, Kagoshima, Japan
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Tattoli L, Maselli E, Romanelli MC, Di Vella G, Solarino B. Complete cardiac rupture associated with closed chest cardiac massage: case report and review of the literature. J Forensic Sci 2014; 59:564-7. [PMID: 24749147 DOI: 10.1111/1556-4029.12340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chest skeletal injuries are the most frequent complications of external chest massage (ECM) during cardiopulmonary resuscitation, but heart and great vessels lacerations that are indeed very rare. We report the case of a 35-year-old workman who collapsed and underwent ECM by his co-workers for almost 30 min. At autopsy, no external injuries, fractures or bruises of the ribs or sternum, were observed. A hemopericardium with a rupture of the heart was found, with no signs of pre-existent cardiac disease. Bruises of thoracic aortic wall, lung petechiae, a contusion of the liver, and bruises of lumbar muscles were found. The cause of death was due to sudden cardiac death with an extensive cardiac rupture. This is an unusual report of massive heart damage without any skeletal or muscle chest injuries, secondary to cardiopulmonary resuscitation. This kind of cardiac lesions may be considered when thoracic–abdominal trauma, or medical history, is unclear.
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Sarinnapakorn V, Natthapongwipas P. A case of anterior mediastinum paraganglioma presented with pericardial effusion two years before symptoms of catecholamine excess: first case report in Thailand. J Med Assoc Thai 2014; 97 Suppl 11:S145-S149. [PMID: 25509709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pheochromocytoma (PCC) and paraganglioma (PGL) are uncommon tumors. Clinical manifestations are mass effect or hormone secretion. The initial manifestation with pericardial effusion is rare. The author presented a case of anterior mediastinum paraganglioma presenting with pericardial effusion two years before symptoms of catecholamine excess. This is the first case reported in Thailand. A 34 year-old female patient presented with dyspnea. There was pericardial effusion from echocardiography was diagnosed with no definite causes of pericardial effusion. After treatment with ibuprofen, pericardial effusion was absolutely resolved from repeated echocardiography. Two years later she had headache and hypertension. Chest X-ray, there was an anterior mediastinal mass. Her 24 hours urine metanephrine was very high. By imaging, an anterior mediastinal mass was observed from CT chest without adrenal mass from CT abdomen. The result of metaiodobenzylguanidine (MIBG) scan was compatible with paraganglioma. Symptoms of headache and hypertension disappeared after surgical removal of the mass. Pericardial effusion may be the first manifestation of paraganglioma especially if the patient had hypertension or could not find the etiology. Thus, pericardial effusion should be investigated for paraganglioma. Due to long term follow-up, this indolent growing tumor may respond to NSAIDs or regress spontaneously.
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Avrel'kina EA, Ignat'eva EN, Fediarova MA, Pliukhin SV. [Nontraumatic chylopericardium and chylothorax in premature neonates]. Arkh Patol 2014; 76:72-74. [PMID: 25543412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Deaths of extremely premature babies undiagnosed as having spontaneous chylopericardium (CP) and chylothorax (CT) are analyzed. The specific features of these death cases are the polyetiology of CP/CT and the similarity of their pathogenesis in the absence of specific clinical symptomatology.
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Ishida M, Kagotani A, Iwai M. Cytological features of lung adenocarcinoma with micropapillary pattern in the pleural or pericardial effusion: analysis of 5 cases. Int J Clin Exp Pathol 2014; 7:5111-5116. [PMID: 25197384 PMCID: PMC4152074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/12/2014] [Indexed: 06/03/2023]
Abstract
Micropapillary pattern is a distinct histopathological pattern, and usually shows a high frequency of lymphatic invasion and lymph node metastases. This pattern is also reported in lung adenocarcinoma, however, only one cytological report of lung adenocarcinoma with micropapillary pattern has been reported. In this study, we analyzed the cytological features of this type of carcinoma in the pleural or pericardial effusion. This study was comprised of 5 consecutive cases of lung adenocarcinoma with micropapillary pattern, in which the tumor cells were present in the pleural or pericardial effusion and whose diagnoses were histopathologically confirmed. The characteristic cytological findings in the pleural or pericardial effusion were as follows: i) tightly cohesive small nests of tumor cells showing papillary structure without fibrovascular core, ii) these nests were comprised of approximately 5-20 tumor cells, iii) cauliflower-like and acinar-like structures were also observed, iv) intracytoplasmic vacuoles were observed in 40% of the cases, and v) the neoplastic cells had large round to oval nuclei containing coarse chromatin and occasional conspicuous nucleoli. It has been reported that the presence of micropapillary structure and intracytoplasmic vacuolation are also characteristic cytological features of micropapillary carcinoma of the urinary bladder, therefore, they are thought to be common cytological features of carcinomas with micropapillary pattern. Consequently, detection of these features can lead to a cytodiagnosis of lung adenocarcinoma with micropapillary pattern in the pleural or pericardial effusion. Recognition of these features is important because this type of tumor shows an aggressive clinical course.
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Affiliation(s)
- Mitsuaki Ishida
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science Shiga, Japan
| | - Akiko Kagotani
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science Shiga, Japan
| | - Muneo Iwai
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science Shiga, Japan
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Dong Y, Zhu D, Dong L, Ren L. Primary cardiac angiosarcoma with pulmonary and lumbar metastases presenting as unexplained pericardial effusion in a 41 year-old man. Heart Lung Circ 2014; 23:e145-6. [PMID: 24529503 DOI: 10.1016/j.hlc.2014.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 12/30/2013] [Accepted: 01/14/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Yijun Dong
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Da Zhu
- Department of Cardiac Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Li Dong
- Department of Cardiac Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Li Ren
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China.
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Affiliation(s)
- Sabrina Godoy Bezerra
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ
- Rede Labs D'Or - Grupo Fleury, Rio de Janeiro, RJ - Brazil
| | | | - Denilson Campos Albuquerque
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ
| | - Rochelle Coppo Militão
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ
- Rede Labs D'Or - Grupo Fleury, Rio de Janeiro, RJ - Brazil
| | - Marcelo Souza Hadlich
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ
- Rede Labs D'Or - Grupo Fleury, Rio de Janeiro, RJ - Brazil
| | - Clerio Francisco Azevedo
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ
- Rede Labs D'Or - Grupo Fleury, Rio de Janeiro, RJ - Brazil
- Mailing address: Clerio Francisco Azevedo Instituto D'Or de Pesquisa e
Ensino - Rua Diniz Cordeiro 30, Botafogo. Postal Code 22281-100, Rio de Janeiro, RJ,
Brazil E-mail: ,
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Zhang L, Zhang Y, Shi X, Zhang Y, Deng G, Lalvani A, Liu X. Utility of T-cell interferon-γ release assays for diagnosing tuberculous serositis: a prospective study in Beijing, China. PLoS One 2014; 9:e85030. [PMID: 24416336 PMCID: PMC3887014 DOI: 10.1371/journal.pone.0085030] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 11/21/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Diagnosis of tuberculous serositis remains a challenge. The aim of this study was to evaluate the diagnostic efficiency of T-SPOT.TB on serous effusion mononuclear cells (SEMC) for diagnosing tuberculous serositis in a high TB burden area. METHODS The present prospective study enrolled patients with suspected tuberculous serositis in a tertiary referral hospital in Beijing, China, to investigate the diagnostic sensitivity, specificity, predictive value (PV), and likelihood ratio(LR) of these tests. Clinical assessment, T-SPOT.TB on SEMC, and T-SPOT.TB on PBMC were performed. Test results were compared with the final confirmed diagnosis. RESULTS Of the 187 participants, 74 (39.6%) were microbiologically or clinically diagnosed as tuberculous serositis and 93(49.7%) were ruled out. The remaining 20 (10.7%) patients were clinically indeterminate and excluded from the final analysis. Compared to that on PBMC, T-SPOT.TB on SEMC showed higher sensitivity (91.9%vs73.0%, P = 0.002), specificity (87.1%vs.73.1%, P = 0.017), PPV (85.0%vs.68.4%, P = 0.013), NPV (93.1%vs.77.3%, P = 0.003), LR+ (7.12vs.2.72) and LR- (0.09vs.0.37), respectively. The frequencies of spot forming cells (SFCs) for T-SPOT.TB on SEMC were 636 per million SEMC (IQR, 143-3443) in patients with tuberculous serositis, which were 4.6-fold (IQR, 1.3-14.3) higher than those of PBMC. By ROC curve analysis, a cut-off value of 56 SFCs per million SEMC for T-SPOT.TB on SEMC showed a sensitivity of 90.5% and specificity of 89.2% for the diagnosis of tuberculous serositis. CONCLUSIONS T-SPOT.TB on SEMC could be an accurate diagnostic method for tuberculous serositis in TB endemic settings. And 56 SFCs per million SEMC might be the optimal cut-off value to diagnose tuberculous serositis.
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Affiliation(s)
- Lifan Zhang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, Peking Union Medical College, International Clinical Epidemiology Network, Beijing, China
| | - Yueqiu Zhang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaochun Shi
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yao Zhang
- Clinical Epidemiology Unit, Peking Union Medical College, International Clinical Epidemiology Network, Beijing, China
| | - Guohua Deng
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ajit Lalvani
- Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Xiaoqing Liu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, Peking Union Medical College, International Clinical Epidemiology Network, Beijing, China
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Nakatsuka SI, Kimura H, Nagano T, Fujita M, Kanda T, Iwata T, Hashimoto K. Self-limited effusion large B-cell lymphoma: two cases of effusion lymphoma maintaining remission after drainage alone. Acta Haematol 2013; 130:217-21. [PMID: 23816805 DOI: 10.1159/000350482] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 02/24/2013] [Indexed: 11/19/2022]
Abstract
We report two cases of human herpesvirus-8 (HHV-8)-negative large B-cell lymphoma involving pericardial and/or pleural effusion that regressed after drainage alone. Case 1 is a 70-year-old man showing massive pericardial effusion. Cytology of the drained effusion showed monotonous infiltration of CD3-, CD20+, CD79a+, and CD138- large B-cells. Monoclonality was shown by Southern blot analysis. Case 2 is a 70-year-old man with massive pericardial and bilateral pleural effusion. Cytology of pericardial effusion showed infiltration of CD20+, CD45RO-, CD138-, immunoglobulin lambda chain+, and kappa chain- large B cells. In both cases, effusion resolved after drainage and no relapse has been observed. HHV-8 was not demonstrated in either case. Clinical presentation of our two cases resembled primary effusion lymphoma (PEL), but cytomorphology, immunophenotype, and prognosis were clearly distinct from those of PEL. HHV-8-negative effusion lymphomas might include prognostically favorable self-limited tumors that could regress without any cytotoxic therapy.
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MESH Headings
- Aged
- Antigens, CD/blood
- Heart Neoplasms/blood
- Heart Neoplasms/pathology
- Heart Neoplasms/therapy
- Heart Neoplasms/virology
- Herpesviridae Infections
- Herpesvirus 8, Human
- Humans
- Lymphoma, Large B-Cell, Diffuse/blood
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Large B-Cell, Diffuse/virology
- Lymphoma, Primary Effusion/blood
- Lymphoma, Primary Effusion/pathology
- Lymphoma, Primary Effusion/therapy
- Lymphoma, Primary Effusion/virology
- Male
- Neoplasm Proteins/blood
- Pericardial Effusion/blood
- Pericardial Effusion/pathology
- Pericardial Effusion/therapy
- Pericardial Effusion/virology
- Pleural Effusion, Malignant/blood
- Pleural Effusion, Malignant/pathology
- Pleural Effusion, Malignant/therapy
- Pleural Effusion, Malignant/virology
- Remission Induction
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Boguradzki P, Drozd-Sokolowska JE, Wieczorek J, Kowalik R, Starczewska M, Krol M, Kobylecka M, Opolski G, Wiktor-Jedrzejczak W. Intrapericardial and intrapleural administration of rituximab to a patient with marginal zone lymphoma. Acta Haematol 2013; 130:169-71. [PMID: 23735747 DOI: 10.1159/000348414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 01/23/2013] [Indexed: 11/19/2022]
Abstract
The addition of rituximab to standard chemotherapy has improved the results of the treatment of B cell non-Hodgkin's lymphomas. Under specific circumstances, it can be administered locally, as an alternative to systemic administration. We administered rituximab intrapericardially in an attempt to control pericardial effusion. We report the case of an 85-year-old woman, diagnosed with marginal zone lymphoma, who developed heart failure due to lymphomatous infiltration of the pericardium. We discuss in detail the possibility of intrapericardial treatment of such patients. The patient received rituximab intrapericardially at a dose of 100 mg in addition to systemic rituximab, cyclophosphamide, vincristine and prednisone immunochemotherapy. The treatment proved to be safe and effective. The patient has remained in good health for more than 3 years at the time of writing. Intrapericardial administration of rituximab may be a valuable therapeutic option for patients with lymphoma that involves the pericardium and heart.
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Affiliation(s)
- Piotr Boguradzki
- Department of Haematology, Oncology and Internal Medicine, The Medical University of Warsaw, Warsaw, Poland
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Kumar A, Kohli A, Verma SK. Fatal cardiac tamponade by Bodkin. Med Sci Law 2013; 53:93-95. [PMID: 23047853 DOI: 10.1258/msl.2012.012021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cardiac tamponade is life-threatening, slow or rapid compression of the heart due to the pericardial accumulation of fluid, pus, blood, clots or gas, as a result of effusion, trauma or rupture of the heart. Penetrating injuries of the chest are most commonly the result of stab wounds and are often associated with a range of potentially life-threatening injuries. It must be treated by pericardial drainage as soon as possible. Sometimes the injury resulting in life-threatening conditions may be so small that it could be missed in the first instance. We present a case report in which the deceased was stabbed by Bodkin at road side. As the wound was so minute, it was not appreciated and time was lost in getting treatment, resulting in loss of a precious life.
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Affiliation(s)
- Arvind Kumar
- Department of Forensic Medicine, University College of Medical Sciences, Delhi, India.
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Suman-Horduna I, Chahal N, Nicholson AG, Alpendurada F, Salukhe TV. Cardiac infiltration from melanoma causing atrio-ventricular block. Eur Heart J Cardiovasc Imaging 2013; 14:606. [PMID: 23302392 DOI: 10.1093/ehjci/jes311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Irina Suman-Horduna
- Department of Cardiovascular Electrophysiology, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK.
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Nakazawa K, Kanemoto K, Suzuki H, Masuda M, Matsuno Y, Iijima H, Ishikawa H. Purulent pericarditis with concurrent detection of Streptococcus pneumoniae and malignant squamous cells in pericardial fluid. Intern Med 2013; 52:1413-6. [PMID: 23774558 DOI: 10.2169/internalmedicine.52.9411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pneumococcal pericarditis complicated by a malignant effusion has not been reported previously. We experienced an independent 62-year-old man with lung cancer who was hospitalized for acute onset of atrial flutter and moderate pericardial effusion. He was afebrile; however, pericardiocentesis showed Streptococcus pneumoniae and malignant squamous cells in purulent pericardial fluid. This case shows that clinicians should keep in mind the possibility of afebrile bacterial pericarditis in cancer patients with pericardial effusions and that cultures of pericardial fluid should be performed in such patients along with cytological examinations.
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Affiliation(s)
- Kensuke Nakazawa
- Department of Respiratory Medicine, Tsukuba Medical Center Hospital, Japan
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Affiliation(s)
- Masaya Yano
- Department of Cardiology, Fukuoka University School of Medicine, Japan
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Haidari G, Gray K, Kirubakaran S. The importance of an ECG: back to basics. BMJ Case Rep 2012; 2012:bcr2012007475. [PMID: 23192583 PMCID: PMC4544328 DOI: 10.1136/bcr-2012-007475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 48-year-old man presented to accident and emergency with syncope on a background history of 3 weeks of increasing shortness of breath. He collapsed at home prompting admission. He was a smoker with a 30-pack-year history. On examination, he was found to be tachypnoeic and hypoxic, with a raised JVP and quiet heard sounds. He was haemodynamically stable and a chest x-ray showed right upper-lobe collapse. His resting ECG demonstrated electrical alternans prompting urgent referral to the cardiologist for echocardiography. This revealed a large pericardial effusion with evidence of right ventricular diastolic collapse. In view of this, he underwent urgent pericardiocentesis. A subsequent CT scan showed bilateral pleural effusions and multiple lung nodules. Both pericardial and pleural fluid cytology were reported as metastatic non-small cell adenocarcinoma. The pericardial fluid continued to reaccumulate requiring a pericardial window. He was referred to the oncology team for palliative chemotherapy.
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Affiliation(s)
- Golaleh Haidari
- Department of Genitourinary Medicine, St Thomas' Hospital, London, UK.
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Schultze D, Müller B, Bruderer T, Dollenmaier G, Riehm JM, Boggian K. A traveller presenting with severe melioidosis complicated by a pericardial effusion: a case report. BMC Infect Dis 2012; 12:242. [PMID: 23035948 PMCID: PMC3532095 DOI: 10.1186/1471-2334-12-242] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 10/01/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Burkholderia pseudomallei, the etiologic agent of melioidosis, is endemic to tropic regions, mainly in Southeast Asia and northern Australia. Melioidosis occurs only sporadically in travellers returning from disease-endemic areas. Severe clinical disease is seen mostly in patients with alteration of immune status. In particular, pericardial effusion occurs in 1-3% of patients with melioidosis, confined to endemic regions. To our best knowledge, this is the first reported case of melioidosis in a traveller complicated by a hemodynamically significant pericardial effusion without predisposing disease. CASE PRESENTATION A 44-year-old Caucasian man developed pneumonia, with bilateral pleural effusions and complicated by a hemodynamically significant pericardial effusion, soon after his return from Thailand to Switzerland. Cultures from different specimens including blood cultures turned out negative. Diagnosis was only accomplished by isolation of Burkholderia pseudomallei from the pericardial aspirate, thus finally enabling the adequate antibiotic treatment. CONCLUSIONS Melioidosis is a great mimicker and physicians in non-endemic countries should be aware of its varied manifestations. In particular, melioidosis should be considered in differential diagnosis of pericardial effusion in travellers , even without risk factors predisposing to severe disease.
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Affiliation(s)
- Detlev Schultze
- Center of Laboratory Medicine, Frohbergstrasse 3, CH-9001 St. Gallen, Switzerland
| | - Brigitt Müller
- Department of Internal Medicine, Cantonal Hospital, Rorschacherstrasse 95, CH-9007 St Gallen, Switzerland
| | - Thomas Bruderer
- Center of Laboratory Medicine, Frohbergstrasse 3, CH-9001 St. Gallen, Switzerland
| | - Günter Dollenmaier
- Center of Laboratory Medicine, Frohbergstrasse 3, CH-9001 St. Gallen, Switzerland
| | - Julia M Riehm
- Bundeswehr Institute of Microbiology, Neuherbergstr 11, D-80937, Munich, Germany
| | - Katia Boggian
- Department of Internal Medicine, Division of Infectious Diseases, Cantonal Hospital, Rorschacherstrasse 95, CH-9007 St Gallen, Switzerland
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Yu SB, Zhao QY, Huang H, Chen DE, Cui HY, Qin M, Huang CX. Prognosis investigation in patients with chronic heart failure and pericardial effusion. Chin Med J (Engl) 2012; 125:882-887. [PMID: 22490591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Researchers still do not reach the consensus on the incidence, characters and the prognostic value of pericardial effusion (PE) in patients with chronic heart failure (CHF). This study is to investigate the incidence, characters and the prognostic value of pericardial effusion (PE) in patients with CHF. METHODS One thousand one hundred and eighty-nine patients, with a diagnosis of CHF consecutively admitted to three centers, were enrolled. M-mode echocardiography was used to determine the presence or absence of PE and to semi-quantify it. The 118 patients with PE and 472 without PE were followed up. The relationship between the PE and other parameters and the prognostic value of PE for CHF were analyzed by univariate and multivariate analyses. RESULTS After following up, 550 patients were analyzed, of which 226 were dead. The incidence of PE was 9.92%. Moderate PE was the most common which account 90.68% (107/118). The 6.78% of the patients (8/118) had small while only 2.54% (3/118) had large one. The systolic blood pressure (OR=1.04, 95%CI (1.01-1.07), P=0.08), left ventricular ejection fraction (LVEF) (OR=1.09, 95%CI (1.02-1.15), P=0.06), and main pulmonary artery diameter (MPAD) (OR=1.51, 95%CI (1.24-1.85), P<0.001) were the independent predictors of PE. The glomerular filtration rate (GFR) (OR=1.013, 95%CI (1.005-1.026), P=0.02), systolic blood pressure (OR=1.02, 95%CI (1.00-1.03), P=0.015), LVEF (OR=1.08, 95%CI (1.04-1.12), P<0.001) and diabetes mellitus (OR=3.53, 95%CI (1.99-6.44), P<0.001) were determined as the independent predictors of CHF prognosis. CONCLUSIONS The PE is not uncommon in CHF patients and most PE are small to moderate. PE is not related to the etiology of CHF while is strongly connected with higher systolic blood pressure, low LVEF and large MPAD. PE dose not increase the risk of death in patients with CHF.
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Affiliation(s)
- Sheng-bo Yu
- Cardiovascular Research Institute of Wuhan University, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China.
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Habib S, Akhter P, Razzak S, Jamal Z, Rasool I, Zaman KS. Presentation of tuberculosis as isolated massive pericardial effusion in a patient with rheumatoid arthritis. J PAK MED ASSOC 2012; 62:65-67. [PMID: 22352108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The case of a 60 year old male patient, diagnosed with rheumatoid arthritis presenting with recurrent massive pericardial effusion, and unresponsive to treatment of rheumatoid arthritis is documented. Pericardial biopsy proved Tuberculous pericarditis with positive fluid culture for Mycobacterium Tuberculosis. Anti-tuberculous treatment was started along with corticosteroids. Follow up after three months showed no evidence of pericardial effusion.
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Affiliation(s)
- Sultana Habib
- National Institute of Cardiovascular Diseases, Karachi
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Singh G, Agarwal S, Iyer VK, Sharma A, Chopra A, Mathur SR. Effusion cytology of granulocytic sarcoma in an unusual clinical scenario: a diagnostic challenge. Acta Cytol 2012; 56:315-20. [PMID: 22555536 DOI: 10.1159/000335058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 11/02/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Presentation of granulocytic sarcoma (GS) as an effusion is very rare and most cases are misdiagnosed as lymphoma infiltration. Detailed descriptions of cytological features of GS in an effusion have not been published to date. CASE REPORT We present the case of a 35-year-old male who presented clinically with a mediastinal mass, peripheral lymphadenopathy and pleural/pericardial effusion. His effusion cytology showed an atypical morphology. Immature cells with marked nuclear indentation/convolution, fine nuclear chromatin, conspicuous nucleoli and a moderate amount of cytoplasm were seen, without any granularity. GS was suspected based on the abnormal nuclear contours and fine nuclear chromatin, and was confirmed by lymph node fine needle aspiration and biopsy with immunocytochemistry. CONCLUSION Abnormal nuclear contours are a significant marker in effusion cytology and provide an important morphological clue to the diagnosis of a myeloid malignancy in addition to fine nuclear chromatin especially in the absence of cytoplasmic granularity. In this case, these features helped to suspect the diagnosis despite a clinical scenario suggestive of non-Hodgkin's lymphoma.
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Affiliation(s)
- Geetika Singh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Lim KC, Chai P, Teo LS. Incidental cardiac abnormalities on non-electrocardiogram-gated multi-detector computed tomography imaging of the thorax and abdomen. Singapore Med J 2011; 52:906-913. [PMID: 22159935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Little attention is usually paid to the heart on non-electrocardiogram (ECG)-gated multi-detector computed tomography (MDCT) imaging of the thorax and abdomen. The current MDCT systems have fast scanning capabilities that render non-ECG-gated images with reduced cardiac motion artefacts due to greater temporal and spatial resolution. This has allowed for better evaluation of the cardiac structures. We present a pictorial review of incidental cardiac abnormalities found on MDCT imaging of the thorax and abdomen performed in our institution. We systematically describe abnormalities involving the pericardium, myocardium, cardiac valves, cardiac chambers, coronary artery and congenital heart disease. Some of these images have echocardiograph and magnetic resonance imaging correlation. The purpose of this pictorial essay is to draw attention to cardiac abnormalities found incidentally on non-ECG-gated MDCT imaging of the thorax and abdomen, which may or may not be related to the patient's symptoms.
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Affiliation(s)
- K C Lim
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074.
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Hidalgo-Urbano RJ, Almendro-Delia M, Villar-Rodríguez JL. [Haemopericardium in a fibrinolysis in acute myocardial infarction secondary to a spontaneous coronary artery dissection]. Rev Esp Cardiol 2011; 64:539-40. [PMID: 21489673 DOI: 10.1016/j.recesp.2010.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 11/01/2010] [Indexed: 11/30/2022]
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Riva V, Bürgesser MV, Calafat P, Diller A, Ruades Ninfea JI, Caballero Escuti G. [Metastatic cardiac tamponade as initial manifestation of papillary thyroid carcinoma]. Medicina (B Aires) 2011; 71:550-552. [PMID: 22167730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Papillary carcinoma, diffuse sclerosing variant corresponds to 2% of all papillary thyroid carcinomas. It is usually diffuse and bilateral, affecting the entire gland. At the time of diagnosis, patients present lymph node and lung metastasis. It affects mainly young women. This case report describes a cardiac tamponade as the initial manifestation of an unusual variant of papillary thyroid carcinoma. A 32 year-old woman was attended at the emergency room with epigastric pain and dry cough. Physical examination revealed hypotension, tachycardia and decreased heart sounds. An echocardiogram confirmed severe pericardial effusion. Pericardial fluid cytology was positive for malignancy. The patient evolved with recurrent pericardial effusion and a pleuropericardial window was performed. At this procedure, a subpleural nodular lesion was found, which histology corresponded to metastases of papillary carcinoma, probably from thyroid origin. Total thyroidectomy was performed. The final diagnosis was papillary carcinoma, diffuse sclerosing variant. This variant infiltrates the connective tissue of the interfollicular spaces, mimicking thyroiditis and it is associated with early vascular permeation. This tumor, compared to the classic variants of thyroid carcinoma, is more aggressive and it has higher risk of recurrence. Papillary thyroid carcinoma should be considered as differential diagnosis in our population, in all metastatic papillary lesions, and even more in young female patients.
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Affiliation(s)
- Verónica Riva
- Servicio de Patología, Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina.
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Uramoto H, Hanagiri T. Video-assisted thoracoscopic pericardiectomy for malignant pericardial effusion. Anticancer Res 2010; 30:4691-4694. [PMID: 21115925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND A malignant thoracic tumour often causes malignant pericardial effusion with cardiac tamponade. However, no standard treatment has yet been established. The purpose of this study was to clarify the utility of performing video-assisted thoracoscopic (VATS) pericardiectomy in patients presenting malignant pericardial effusion. PATIENTS AND METHODS VATS pericardiectomy was performed for 11 patients with malignant pericardial effusion from 2000 to 2010. The clinical characteristics and outcome of these patients were retrospectively analysed. Pericardial windows were created under general anaesthesia and single lung ventilation was performed using three trocars. RESULTS All patients were successfully managed by thoracoscopic resections. There were no surgical difficulties and the postoperative periods were uneventful. The performance status and Hugh-Jones classification both improved after treatment in nine and eight out of eleven cases, respectively. The average duration of chest tube drainage was seven days. No recurrent pericardial effusion was noted during follow-up. CONCLUSION The thoracoscopic approach was able to safely resect a sufficient amount of the pericardium and to provide sufficient surgical visualisation while being minimally invasive for patients with malignant pericardial effusion.
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Affiliation(s)
- Hidetaka Uramoto
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
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