Neoplastic Pericardial Effusion in Malignant Solid Tumors: Clinical Features, Diagnosis and Management

Abstract

Introduction: Neoplastic pericardial effusion (NPE) poses a significant challenge in medical pathology, particularly due to its association with secondary involvement by malignancies originating in various organs. Timely management of NPE is pivotal for both overall survival and the patients' quality of life. However, there is a scarcity of data on NPE in our country. This study aims to provide a comprehensive description of the clinical, diagnostic, and therapeutic characteristics of consecutive Moroccan patients with NPE. Methods: A retrospective cohort study was conducted at Ibn Rochd Cardiology Department and Oncology Unit in Casablanca, covering a period of three years (January 2020 to December 2022). The study included patients diagnosed with NPE based on clinical, biological, histological, and echocardiographic criteria. Data collection encompassed sociodemographic information, performance status, clinical manifestations, ECG and echocardiography findings, grade of pericardial effusion, cytology of pericardial fluid, and details of therapeutic protocols administered. Results: Between 2020 and 2022, 49 NPE patients were admitted, with a gender distribution of 51% men and 49% women. The median age was 42 years. Most patients presented with symptomatic pericardial effusion (81%), and 61.2% had NPE at the first diagnosis of metastatic disease. Lung, breast, and other solid tumors were common etiologies. Cytology of pericardial fluid was positive in 23 patients. Clinical examination and diagnostic imaging revealed diverse presentations, including signs of right heart failure, ECG abnormalities, and echocardiographic findings indicative of significant pericardial effusion. Pericardiocentesis and drainage were performed in the majority of patients, often combined with pleuropericardial window placement. Systemic treatments, tailored to the primary tumor type, were administered, with a 60% overall mortality rate, rising to 88% in lung cancer cases. Conclusion: This study provides crucial insights into the clinical spectrum and management of NPE in Moroccan patients. The high mortality rate, particularly in lung cancers, underscores the importance of early detection and targeted therapeutic interventions in improving outcomes for patients with NPE.