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.
Pericardial effusions with a cardiac tamponade constitute a surgical emergency and the pericardiocentesis represents the first class therapeutic recommendation. 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 10 year period were studied by cytology and results were compared with pericardial histology results. 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. There was no any false negative result in comparison with histology.
Conclusions. Cytology provides an immediate and accurate means of diagnosis. Immunocytology is very important in the diagnostic evaluation.
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1. GORNIK H.L. GERHARD-HERMAN M. BECKMAN J.A. Abnormal cytology predicts poor prognosis in cancer patients with pericardial effusion. J Clin Oncol. 2005; 2 3(22):5211-6.
2. MAISCH B.I. SEFEROVIĆ P.M. RISTIĆ A.D. et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J. 2004 Apr; 25(7):587-610.
4. LEWINTER M.M. TISCHLER M.D. Pericardial diseases. In: Bonow R.O. Mann D.L. Zipes D.P. Libby P. eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. Ed 9. Philadelphia 2011 Saunders 1651-1670.
5. SAGRISTÀ-SAULEDA J. MERCÉ J. PERMANYER-MIRALDA G. SOLER-SOLER J. Clinical clues to the causes of large pericardial effusions. Am J Med. 2000; 109(2):95-101.
6. MAGGIOLINI S. OSCULATI G. VITALE G. Utility and safety of diagnostic pericardiocentesis. European Heart Journal 2005; 26(10):1046-7.
7. SIDAWY M.K ALI S.Z. Fine needle aspiration cytology. Elsevier Health Sciences 2007.
8. RIZZARDI C. BARREZI E. BROLLO A. CASSETTI P. SCNEIDER M. MELATO M. Primary pericardial mesothelioma in an asbestos-exposed patient with previous heart surgery. Anticancer Research 2010; 30 (1):1323-6.
9. KWON H.Y. CHO K.I. KIM S.M. et al. A rare case with primary undifferentiated carcinoma of pericardium. Journal of Cardiovascular Ultrasound. 2010; 18(3):104-107.
10. PETCU D.P. PETCU C. POPESCU C.F. BĂTĂIOSU C. ALEXANDRU D. Clinical and cytological correlations in pericardial effusions with cardiac tamponade. Rom J Morphol Embryol. 2009; 50(2):251-6.
11. KOSS G.L. MELAMED M.R. Effusions in the absence of cancer and effusions in the presence of cancer. In: Koss G.L. Melamed M.R. (eds) Koss’ diagnostic cytology and its histopathologic bases 5th edition Lippincott Williams & Wilkins Philadelphia 2006.
12. REUTER H. BURGESS L. VAN VUUREN W. DOUBELL A. Diagnosing tuberculous pericarditis. QJM 2006; 99(12):827-39.
13. FIOCCO M. KRASNA M.J. The management of malignant pleural and pericardial effusions. Hematol Oncol Clin North Am 1997; 11(2):253-65.
14. WANG P.C. YANG K.Y. CHAO J.Y. LIU J.M. PERNG R.P. YEN S.H. Prognostic role of pericardial fluid cytology in cardiac tamponade associated with non-small cell lung cancer. Chest 2000; 118(3):744-749.
15. DRAGOESCU E.A LIU L. Pericardial fluid cytology: An analysis of 128 specimens over a 6 year period. Cancer Cytopathol. 2013 121:242-251.
16. HAE-OK JUNG. Pericardial effusion and pericardiocentesis: Role of echocardiography. Korean Circ J. 2012; 42(11): 725-34.
17. KARATOLIOS K. PANKUWEIT S. MAISCH B. Diagnostic value of biochemical biomarkers in malignant and non-malignant pericardial effusion. Heart Fail Rev. 2013; 18(3):337-44.