Definition/General
Introduction:
Malignant pericardial effusion contains neoplastic cells
Results from metastatic disease (90%) or primary pericardial tumors (10%)
Common primaries: lung, breast, lymphoma, melanoma
Poor prognostic indicator
May cause cardiac tamponade.
Origin:
Results from hematogenous spread
Direct extension from mediastinal tumors
Lymphatic spread
Primary mesothelioma (rare).
Classification:
Based on primary: lung adenocarcinoma (40%)
Breast carcinoma (25%)
Lymphoma (15%)
Melanoma (10%)
Unknown primary (10%).
Epidemiology:
Accounts for 5-15% of pericardial effusions
Male predominance (lung cancer)
Poor prognosis: median survival 3-6 months.
Clinical Features
Presentation:
Progressive dyspnea
Chest pain
Cardiac tamponade
Pericardial friction rub
Jugular venous distention.
Symptoms:
Dyspnea (85% cases)
Chest pain (70% cases)
Fatigue (60% cases)
Cough (45% cases)
Syncope (tamponade).
Risk Factors:
Known malignancy
Mediastinal radiation
Advanced cancer stage.
Screening:
Echocardiography
CT chest
Pericardiocentesis
Tumor markers.
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Microscopic Description
Histological Features:
Malignant cells in clusters and single cells
Cytological atypia
High nuclear-cytoplasmic ratio
Prominent nucleoli
Mitotic activity.
Cellular Characteristics:
Large pleomorphic cells
Hyperchromatic nuclei
Irregular nuclear contours
Increased cell size.
Architectural Patterns:
Three-dimensional clusters
Loss of cohesion
Papillary fragments
Necrotic background.
Grading Criteria:
Nuclear atypia grading
Mitotic count
Architectural complexity.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
Pericardial fluid, volume [X] mL, [appearance]
Malignant Cells
POSITIVE for malignant cells
Final Diagnosis
MALIGNANT pericardial effusion - [Tumor type] consistent with [primary site]