[341] An Analysis of 961 Pericardial Fluid Samples Obtained over an 18-Year Period.

Indu S Basil, Muhammad Idrees, Rebecca Marks, Harvey Cramer. Indiana University School of Medicine, Indianapolis

Background: Malignant pericardial effusion is a relatively uncommon, but ominous complication of advanced malignancy usually seen in severely ill patients with multiple visceral metastases. The overall survival of patients with malignant pericardial effusion is primarily influenced by the extent and histopathology of their underlying primary malignancy.
Design: A computerized search of our LIS was performed for the period beginning July 1992 through June 2010 and all pericardial fluid cytology reports were reviewed. All correlating surgical pathology and relevant clinical information was extracted from a review of the electronic medical records of all of the malignant cases. The spectrum of different primary malignancies and prognostic significance of the malignant pericardial effusions was determined when adequate information was available.
Results: During this 18-year period, there were a total of 961 pericardial fluid samples accounting for 4% of all of the effusion cytology cases. Of the 961 cases, 828 were reported as benign (86%) and 133 (14%) were malignant. There were a total of 121 metastatic carcinomas (Table 1), 2 mesotheliomas, 9 hematologic malignancies and 1 germ cell tumor. The primary site for 80 metastatic malignancies (Table 2) included lung, breast, ovary, thymus, kidney, esophagus and pancreas. For the remaining 41 cases (34%), the primary site could not be established. The nine hematologic malignancies included 7 lymphomas and 2 myelomas. Almost all patients with follow-up information were treated with pericardial drainage or window, without chemotherapy instillation into the pericardium.

Table 1.

Types of metastatic carcinoma	Adenocarcinoma	Non-small cell carcinoma	Poorly differentiated carcinoma	Squamous cell carcinoma	Small cell carcinoma	Thymic tumors
Number of cases	74	23	12	7	3	2
Percentage of cases	61%	19%	10%	6%	3%	2%

Table 2.

Primary sites	Lung	Breast	Ovary	Unknown primary	Others (kidney, thymus, pancreas, esophagus)
Number of cases	41	28	5	41	6
Percentage of cases	34%	23%	4%	34%	5%

Conclusions: Malignant pericardial effusions account for only a minority (14%) of all the pericardial effusions examined at our institution. Metastatic carcinomas account for more than 90 percent of these malignancies with lung and breast being the most common primary sites. However, for a significant percentage of patients with metastatic carcinoma (34%), the primary site of the metastatic carcinoma was unknown. While most patients did poorly, a few patients, surprisingly, survived many years following their diagnosis of a malignant pericardial effusion.
Category: Cytopathology

Wednesday, March 2, 2011 1:00 PM

Poster Session VI # 71, Wednesday Afternoon