Pericardial involvement in neoplastic disease

Abstract

Pericardial layer involvement in cancer patients is not rare and varies from malignant processes to therapy side effects (e.g. local irradiation). Primary pericardial masses are rare—mesothelioma being the most common—and have a poor prognosis. Secondary metastases to the pericardium form the majority of pericardial neoplasms with lung carcinoma being the most prevalent. Patients with neoplastic involvement of the pericardium may present with pericardial effusion that can deteriorate to life-threatening cardiac tamponade which carries a very poor prognosis. Diagnosis of neoplastic involvement of the pericardium is of clinical significant but carries diagnostic challenges. Symptoms such as dyspnoea or chest pain are not specific and diagnosis is usually incidental through imaging studies or diagnosed at a late stage when large effusions are present. In cases of large pericardial effusion or repetitive effusion with unknown aetiology, further investigation is advised by drainage of pericardial fluid (pericardiocentesis) for diagnostic purposes and relief of symptoms. Different diagnostic tests performed on pericardial fluid exist in practice with cytology and pathology as the gold standard, but may fail to detect neoplastic cells in some cases. Although carrying a poor prognosis, pericardial investigation and treatment should be considered in patients with suspected pericardial involvement and may prolong and improve quality of life, especially if detected early.