Cardiac tamponade due to advanced gastric cancer: a pathomorphological systematic review of clinical cases

Abstract

Annotation. Pericardial involvement due to gastric cancer is uncommon, especially when it’s secondary to direct transdiaphragmatic tumor infiltration, and its manifestation in the form of cardiac tamponade is an exceptional situation. The aim of this review is to provide a pathomorphological overview of three rare clinical cases of cardiac tamponade, which was the first clinical manifestation of advanced gastric cancer. To realize the goal, a meta-analysis of 15 publications included in the Medline and Scopus scientific databases was conducted. The statistical substantiation of the research was carried out using Microsoft Excel 2016 and Statistica 12.0. According to the results of histological analysis, these three cases of gastric cancer were classified as: poorly differentiated adenocarcinoma of the antrum in a 52-year-old patient; sarcomatoid carcinoma of the fundus in a 49-year-old patient; and scirrhous carcinoma of the fundus in a 70-year-old patient. The tropism of gastric tumor infiltration into the pericardium is substantiated with the help of transforming growth factor, which increases the expression of CD44 adhesion molecules in tumor cells and stimulates the ability of the tumor to infiltrate the pericardium due to adhesion to the mesothelium. The hepatocyte growth factor, which enhances the invasive properties of the tumor, also played an important role: the C-Met receptors were determined on tumor cells in all cases. Thus, cardiac tamponade, which is a terminal condition, can occur in patients with various histological types of gastric cancer, including the three described. Furthermore, in the medical literature this over review is probably the only one attempt to analyze cardiac tamponade due to advanced gastric cancer with a comparison of different clinical cases.