Malignant pericardial effusion
Shortness of breath and chest pain.
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Very large pericardial effusion. Small right pleural effusion. No pulmonary embolus.
The patient had a known history of non small cell lung cancer (not well seen on the lung windows), and went on to have pericardial drainage and biopsy.
MACROSCOPIC DESCRIPTION: "Pericardium": A irregular piece of fibrous tissue 27x18x6mm with a smooth pale pink surface on one aspect and rough tissue on the other. Specimen serially sectioned.
MICROSCOPIC DESCRIPTION: Sections of pericardium show fibroadipose tissue with diathermy artefact. The pericardial surface demonstrates organising granulation tissue with mixed inflammatory cells. Beneath the fibrous layer there is haemorrhage and fibrin containing cohesive tumour cells forming nests and papillae. Tumour cells contain abundant eosinophilic cytoplasm, oval vesicular nuclei and prominent nucleoli. Immunohistochemical results show tumour cells stain: TTF1+, BerEP4+, WT1- and Calretinin weak+; consistent with metastatic primary lung adenocarcinoma.
DIAGNOSIS: Pericardium: Metastatic primary lung adenocarcinoma.
Malignancy is a common cause of pericardial effusion, with common primaries being lung, breast and lymphoma/leukaemia.