Pericardial Metastasis Research Articles

EP1.16-19 Expected Years of Life Loss and Survival Outcome in Non-Small Cell Lung Cancer Patients in Rajavithi Hospital

To determine expected years of life loss (EYLL) that was the burden of disease parameter of all stages non-small cell lung cancer (NSCLC) patients, survival outcomes in advanced NSCLC patients and association between clinical prognostic factors and survival outcomes in advanced diseases. This retrospective cohort study was conducted by reviewing 305 eligible all stages NSCLC patients treated at Oncology Unit, Department of Medicine, Rajavithi hospital from 2011 to 2015. The iSQoL statistical package was used to evaluate EYLL compared to the reference Thai population. For advanced NSCLC patients, univariate and multivariate analysis were used to determine prognostic factors associated with survival outcomes. Total 305 patients were included for EYLL analysis. From survival extrapolation, corresponding EYLL of stage I, II, III, and IV NSCLC patients were 9.20, 15.61, 18.03, 20.23 years, respectively. Male patients had EYLL less than female patients (18.81 years vs 20.70 years). In advanced NSCLC, 261 patients were included in survival and prognostic factors analysis. The median overall survival was 6.08 months. The clinical parameters associated with poor survival outcomes in multivariate analysis were male gender (HR 1.71; p = 0.017), presentation with cough or hemoptysis (HR 1.81; p <0.001), significant weight loss (HR 1.80; p <0.001), SVC obstruction (HR 1.98; p = 0.019), pathological fracture (HR 2.16; p = 0.002), symptomatic brain metastasis (HR 2.05; p = 0.005), pericardial metastasis (HR 1.88; p = 0.015), adrenal metastasis (HR 1.58; p = 0.011), and not received palliative chemotherapy (HR 6.18; p <0.001).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Diagnosis and treating patients with NSCLC as early as possible would be save more life-years from 18 – 20 years in advanced disease to 9 – 15 years in early stage disease. In advanced NSCLC patients, palliative chemotherapy was the most important factor related to better survival outcomes.

SARCOMA METASTASIS CAUSING ATRIAL FIBRILLATION AND REFRACTORY PLEURAL EFFUSION

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Lungs are a primary site for metastasis of sarcomas, however malignant pleural effusion, which indicates a more widespread disease, are much rarer representing only 1-6% of all malignant effusions. We describe a case of a young man with a low-grade pelvic sarcoma that had progressive metastatic lung disease who went on to develop a refractory pleural effusion and new-onset atrial fibrillation CASE PRESENTATION: A 43-year-old male diagnosed with low-grade sarcoma in the pelvis had undergone a left hemipelvectomy. Nine months later he developed metastatic disease and underwent radiation/chemotherapy and eventually Nivolumab trial with no improvement of the disease. The patient then presented three months later with respiratory distress and atrial fibrillation (Afib). A Computed Tomography Scan(CT) of the chest showed increased muscular, bone, lung, and now pleural/ possible pericardial metastases. The CT also showed a large right-sided pleural effusion. The patient underwent thoracentesis with pleural fluid analysis demonstrating an exudative effusion, with cytology showing rare atypical large cells with high nuclear/cytoplasmic ratio consistent with malignant pleural effusion. Echocardiogram showed a new pericardial space mass likely a metastatic deposit. It was felt that mass contributes to persistent Afib. Due to recurrent pleural effusions, the patient received a PleurX catheter. This PleurX catheter initially drained well but later failed to continue to drain fluid and was removed. He later required admission to ICU due to acute hypoxic and hypercapnic respiratory failure. The patient failed to improve with non-invasive ventilation. The family declined intubation and the patient passed away on comfort measures. DISCUSSION: Metastatic pulmonary metastases arise most commonly in patients with malignant fibrous histiocytoma, synovial sarcoma, liposarcoma, & leiomyosarcoma, especially if histology is high grade. Lower grade sarcomas are considered more indolent and lung metastatic rate is lower. In our case, the patient had low-grade sarcoma which makes it more unusual. Complete resection of metastasis, when feasible, is the most important factor in determining post-metastasis survival, with the median survival of 33 months vs median survival of 11 months if resection is not done. This was not able to be done in our patient. When metastasis to the pericardium occurs it is common to see arrhythmias on ECG; the most common being PAC’s, PVC’s, and SVT's such as Afib as in our patient CONCLUSIONS: Metastatic progression of sarcoma to the lung can be managed surgically and with chemotherapy in select patients but prognosis remains poor. Pleural involvement, especially with malignant effusion, portends a very poor prognosis Reference #1: Cates CU, Virmani R, Vaughn WK, et al. Electrocardiographic markers of cardiac metastasis. Am Heart J 1986;112:1297–303. Reference #2: Marulli G, Mammana M, Comacchio G, Rea F. Survival and prognostic factors following pulmonary metastasectomy for sarcoma. J Thorac Dis. 2017;9(Suppl 12):S1305-S1315. Reference #3: Yildirim H1, Metintaş M, Ak G, Dündar E, Erginel S. Soft tissue sarcoma metastatic to pleura. Tuberk Toraks. 2008;56(2):197-200 DISCLOSURES: No relevant relationships by Edward Conuel, source=Web Response No relevant relationships by Lezah McCarthy, source=Web Response No relevant relationships by Kristoffer Neu, source=Web Response No relevant relationships by Raina Patel, source=Web Response No relevant relationships by Muhammad Salick, source=Web Response No relevant relationships by Ali Wazir, source=Web Response No relevant relationships by Robert Wilcott, source=Web Response

Computed Tomography Imaging Characteristics of Non–Small-Cell Lung Cancer With Anaplastic Lymphoma Kinase Rearrangements: A Systematic Review and Meta-Analysis

IntroductionSeveral studies have suggested that non–small-cell lung cancer (NSCLC) patients who harbor anaplastic lymphoma kinase (ALK) rearrangement might have different imaging features compared with those without the rearrangement. The goal of this work was to systematically investigate the computed tomography (CT) imaging features of ALK-rearranged NSCLC. Materials and MethodsWe searched published studies that investigated CT imaging features of ALK-rearranged NSCLC compared with ALK-negative, including epidermal growth factor receptor (EGFR)-mutant and ALK/EGFR-negative, NSCLC. We extracted clinicopathologic characteristics and CT imaging features of patients in the included studies. Features were compared and tested in the form of odds ratios (ORs) or weighted mean differences at a 95% confidence interval. ResultsTwelve studies with 2210 patients with NSCLC were included. Compared with ALK-negative NSCLC, ALK-rearranged NSCLC was more likely to be solid (OR, 2.37; P < .001) and less likely to have cavitation (OR, 0.45; P = .002). In advanced stages, patients with ALK-rearranged NSCLC, compared with EGFR-mutant NSCLC, were more likely to have lymphadenopathy (OR, 3.47; P < .001), pericardial metastasis (OR, 2.18; P = .04), pleural metastasis (OR, 2.07; P = .004), and lymphangitic carcinomatosis (OR, 3.41; P = .02), but less likely to have lung metastasis (OR, 0.52; P = .003). Compared with ALK/EGFR-negative NSCLC, ALK-rearranged NSCLC was more likely to have lymphangitic carcinomatosis (OR, 3.88; P = .03), pleural metastasis (OR, 1.89; P = .02), and pleural effusion (OR, 2.94; P = .003). ConclusionALK-rearranged NSCLC has imaging features that are different compared with EGFR-mutant and ALK/EGFR-negative NSCLC. These imaging features might provide clues as to the presence of ALK rearrangement and help in the selection of patients who might benefit from expedited molecular testing or repeat testing after a negative assay.

Imaging Depiction of Large Pericardial Metastasis From Osteosarcoma of Tibia

Imaging Depiction of Large Pericardial Metastasis From Osteosarcoma of Tibia

New insights into the impact of primary lung adenocarcinoma location on metastatic sites and sequence: A multicenter cohort study

IntroductionThe presence of organ metastases is a major factor for unfavorable prognosis in lung adenocarcinoma (LADC). However, the influence of primary tumor location on metastatic sites and sequence has not been extensively analyzed. MethodsWe performed a multicenter cohort study, evaluating clinicopathological data of 1126 Caucasian LADC patients, focusing on the distinct location of primary tumors and metastatic sites during disease progression. ResultsMetastases to the lung (p < 0.001), pleura (p < 0.001) and adrenal glands (p < 0.001) occurred earlier during disease progression and central primary tumors were associated with early metastases (OR 1.43, p = 0.02). In secondary exploratory analysis we found that bone metastases were more frequent in patients with central tumors (OR 1.86, p = 0.017), whereas lung metastases in those with peripheral tumors (OR 1.35, p = 0.015). Central primary LADCs were associated with decreased median overall survival (vs. peripheral tumors, 10.2 vs. 22 months) both in univariate (HR 2.075, p = 0.001) and in multivariate (HR 1.558, p < 0.001) analyses and independent from stage and T factor. By subsequent analysis, we found that bone metastases tend to appear together with adrenal and liver metastases, and adrenal with skin, and pleural with pericardial metastases more frequently than expected if metastatic events occurred independently. ConclusionThis comprehensive large cohort analysis demonstrates metastatic site- and sequence-specific variations in patients with LADC. Central LADC is associated with early metastatic disease, bone involvement and, consequently, decreased survival.

Pleural or pericardial metastasis: A significant factor affecting efficacy and adverse events in lung cancer patients treated with PD-1/PD-L1 inhibitors.

BackgroundImmunotherapy is a new paradigm for the treatment of non‐small‐cell lung cancer (NSCLC), and targeting the PD‐1 or PD‐L1 pathway is a promising therapeutic option. Although PD‐1/PD‐L1 inhibitors are more effective than standard chemotherapy in lung cancer, clinicians are afraid to actively use them because of hyperprogression and pseudoprogression. The aim of this study was to investigate the factors associated with tumor response and serious outcomes.MethodsWe retrospectively collected the medical records of 51 patients with advanced NSCLC who received PD‐1/PD‐L1 inhibitors between January 2016 and February 2018.ResultsThe mean patient age was 63.9 years, and 72.5% (37/51) were male. Most (92.2%, 47/51) had received previous systemic treatment. The overall response rate was 21.6% (11/51). The response rate was significantly lower in patients with pleural or pericardial metastasis than in patients without pleural or pericardial metastasis (4.3% vs. 35.7%; P = 0.007). Patients with pleural or pericardial metastasis had a significantly higher rate of adverse events of any grade (91.3% vs. 50.0%; P = 0.002) and grade 3–5 adverse events (52.2% vs. 25.0%; P = 0.046).ConclusionPleural or pericardial metastasis is a significant factor affecting the efficacy and rate of adverse events in advanced NSCLC patients treated with PD‐1/PD‐L1 inhibitors. Clinicians should pay attention to the use of immune checkpoint inhibitors in lung cancer patients with pleural or pericardial metastasis.

AB029. Recurrent pulmonary inflammatory myofibroblastic tumor with pleural metastasis, case report and literature review

: Pulmonary inflammatory myofibroblastic tumor (IMT) represents an extremely rare type of inflammatory pseudotumor that appears most commonly in children and young individuals. It remains controversial whether an IMT is a reactive inflammatory lesion or a true neoplasm with malignant potential. The treatment of choice for myofibroblastic tumor is surgery, and recurrence is known to be rare. Herein we report a 71-year-old patient with initial presentation of solitary lung tumor with pleural effusion. Pathology report confirms the diagnosis of pulmonary IMT. Aggressive recurrent IMT with diffuse pleural seeding and pericardial metastasis is detected three months later after diagnostic surgery. Purpose of the report is through a literature review to highlight the existence of the rare malignant presentation of IMT.

Cardiac Angiosarcoma: A Rare Cause of Recurrent Pericardial Effusion

SESSION TITLE: Cardiovascular Disease SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Cardiac angiosarcoma is a rare entity. Early diagnosis is delayed due to generalized symptoms. Diagnosis is made when specific symptoms related to tumor growth are investigated. CASE PRESENTATION: A 20 y/o female presented with pleuritic chest pain, treated as pericarditis. After one month, she developed fatigue and dyspnea. CT chest was remarkable for bilateral pleural effusions and pericardial effusion. She underwent pericardiocentesis. Pericardial bacterial and fungal evaluation was unrevealing. ANA, anti dsDNA, antihistone, complement levels, RF, HIV, acute hepatitis panel, RPR, coccidiomycosis and CMV titers, toxoplasma Ab, ANCA levels, coxsackie B, and IgM EBV were negative. She had a positive IgG EBV and her symptoms were attributed to viral perimyocarditis. She continued to have right-sided chest pain and was admitted to the hospital after three months. Her vital signs and physical examination were unremarkable. Cardiac MRI revealed a large mass, 4.1 x 6.3 x 4.8 cm, anterior to the right atrium and extending to the AV groove and proximal SVC, along with a moderate pericardial effusion. On perfusion images, there was gadolinium uptake at the anterior most part of the tumor with three hypoperfused areas portraying vascularity. Left heart catheterization showed extensive vascularization in the angiographic location of the right atrium where the tumor was located. She underwent tumor resection. The mass was extensive, beyond the right atrial free wall, on the right ventricle surface, pericardial metastasis and underneath an innominate vein on top of the aorta. Pathology displayed an aggressive high-grade angiosarcoma with a sheet-like growth pattern. Tumor cells had CD31 membranous and ERG nuclear staining. She was stable after surgery and further managed with paclitaxel. DISCUSSION: Over the years, the diagnosis of cardiac sarcomas has improved due to a combination of physical examination, ekg, cardiac catheterization, echocardiography, CT scan and MRI. It mostly involves the right atrium, presenting as pericardial effusion and/or cardiac tamponade in about 56% of cases. Complete or partial surgical resection is done for palliation or complete cure. Angiosarcomas are mostly resistant to chemotherapy and radiotherapy. However, recently paclitaxel and pegylated-liposomal doxorubicin have shown efficacy in treating angiosarcoma. CONCLUSIONS: Overall, even with the new imaging techniques for diagnosis and management, cardiac sarcomas still carry a poor prognosis with a 5-year survival rate of 14%. Reference #1: Blackmon, Shandra H., and Michael J. Reardon. “Surgical Treatment of Primary Cardiac Sarcomas.” Texas Heart Institute Journal 36.5 (2009): 451-452. Reference #2: Loukas, Marios. “Primary Cardiac Angiosarcoma - A Review”. Medical Science Monitor 20 (2014): 103-109. Reference #3: Skubitz, Keith M., and Philip A. Haddad. “Paclitaxel And Pegylated-Liposomal Doxorubicin Are Both Active In Angiosarcoma”. Cancer 104.2 (2005): 361-366. DISCLOSURE: The following authors have nothing to disclose: Sidra Khalid, Richard Meredith, Allan Klein No Product/Research Disclosure Information

Imaging characteristics of cardiac metastases in patients with malignant melanoma

BackgroundDue to prolonged survival and technical advances in CT imaging, cardiac metastases in patients with malignant melanoma are observed more frequently nowadays. The aim of the present study was to assess the anatomic distribution as well as the morphologic and histologic appearance of cardiac metastases from malignant melanoma.MethodsTwenty five patients with known metastasized melanoma and with incidental finding of cardiac metastases during routine staging CT were retrospectively included in this study. CT images were assessed for the presence, localization and extent of cardiac metastases. Histological results, mutational analysis and tumor markers were reviewed.ResultsFourteen out of 25 patients presented with singular cardiac mass (56%), whereas ten patients (40%) presented with multifocal and one patient with disseminated cardiac metastases. Twelve patients presented with endocardial (48%), eight with myocardial and two with pericardial metastases. Most frequent site involved in endocardial metastases was the right atrium (67%) followed by the right ventricle (33%). There seems to be a correlation between histological subtype and location of cardiac metastasis. Median survival after diagnosis of cardiac metastases was 8 months, with no significant difference regarding the localization of metastases within the heart.ConclusionCardiac metastases can involve every part of the heart possibly in dependence of histological subtype. The awareness of different types of cardiac metastases and their characteristic appearance on CT images is necessary for further investigations and might contribute to targeted therapy.

Metastatic pulmonary artery sarcoma presented with tamponade: a case report

Key Clinical MessagePulmonary artery sarcoma is a rare tumor with varying presentations including pericardial effusion and pulmonary metastasis. Single‐nucleotide polymorphism array is a novel method that can be used to define tumor genome and be used as a guidance to choose the proper treatment regimen.

Metastatic Malignant Mesothelioma Presenting With Cardiogenic Shock

Metastatic tumor progression to the pericardium is generally characterized by pericardial effusion with or without tamponade. It is extremely rare for tumor to metastasize to the pericardium and cause constrictive pericarditis and tamponade physiology. We report a case of metastatic malignant mesothelioma admitted to our facility for acute hypoxic respiratory failure and cardiogenic shock due to extensive pericardial metastasis and trapped heart. This was confirmed during post-mortem evaluation, which showed malignant mesothelioma involving the anterior mediastinum and partially encasing the heart and the root of the aorta in addition to fibrous pericarditis and pericardial adhesion. J Med Cases. 2017;8(2):58-60 doi: https://doi.org/10.14740/jmc2739w

Метастатическое поражение перикарда в рутинной цитологической диагностике перикардиального выпота (с описанием клинических случаев)

Метастатическое поражение перикарда в рутинной цитологической диагностике перикардиального выпота (с описанием клинических случаев)

CT staging and preoperative assessment of resectability for thymic epithelial tumors.

The aim of this study was to determine the computed tomography (CT) features potentially helpful for accurate staging and predicting resectability of thymic epithelial tumors (TET). One hundred and thirty-eight consecutive TET patients undergoing surgical resection from April 2010 to November 2011 were prospectively entered into a database. All patients were staged according to the Masaoka-Koga staging system. The relationship between CT features with tumor staging and complete resection was reviewed after surgery. Surgico-pathological staging was stage I in 63, stage II in 32, stage III in 32, and stage IV in 11 patients. Preoperative CT staging was highly consistent with postoperative surgico-pathological staging (Kappa =0.525). Tumor shape, contour, enhancement, with or without invasion of the adjacent structures (mediastinal fat, mediastinal pleura, lung, pericardium, mediastinal vessels, phrenic nerve), and presence of pleural, pericardial effusionor intrapulmonary metastasis were correlated with Masaoka-Koga staging (P<0.05). However, tumor size, internal density or presence of calcification was not associated with staging (P>0.05). Tumor size, presence of calcification and mediastinal lymph node enlargement were not correlated with complete tumor resection (P>0.05). Tumor shape, contour, internal density, enhancement pattern, and invasion of adjacent structures were related to complete resection of the primary tumor in univariate analysis (P<0.05). However, upon multivariate logistic regression, only absence of artery systems invasion was predictive of complete resection (P<0.05). Clinical staging of TET could be accurately evaluated with CT features including tumor shape, contour, enhancement pattern, with or without invasion of adjacent structures, and presence of pleural, pericardial effusion or intrapulmonary metastasis. Absence of arterial system invasion on CT was the only predictive feature for predicting complete resection of TET.

Cardiac Relapse of Acute Myeloid Leukemia after Allogeneic Hematopoietic Stem Cell Transplantation

Secondary or metastatic cardiac tumors are much more common than primary benign or malignant cardiac tumors. Any tumor can cause myocardial or pericardial metastasis, although isolated or combined tumor invasion of the pericardium is more common. Types of neoplasia with the highest rates of cardiac or pericardial involvement are melanoma, lung cancer, and breast and mediastinal carcinomas. Acute myeloid leukemia (AML) is the most common type of acute leukemia in adults. Initial treatment involves chemotherapy followed by consolidation treatment to reduce the risk of relapse. In high-risk patients, the treatment of choice for consolidation is hematopoietic stem cell transplantation (HSCT). Relapse of AML is the most common cause of HSCT failure. Extramedullary relapse is rare. The organs most frequently affected, called “sanctuaries,” are the testes, ovaries, and central nervous system. We present a case with extramedullary relapse in the form of a solid cardiac mass.

Pericardial metastases from BRCA1-associated peritoneal cancer. Case report

Women with BRCA1 gene mutations have about 30 to 40 times higher risk of ovarian cancer compared to the population risk (the lifetime risk of BRCA1-dependent ovarian cancer is about 40 percent). Because of the high risk BRCA1 mutations carriers at the age of about 40 are recommended prophylactic salpingo-oophorectomy (after completion of reproductive plans). After the surgery there is still a risk of peritoneal cancer which histologically resembles ovarian cancer, but it is much lower than the risk of ovarian cancer before salpingo-oophorectomy: the cumulative risk of developing cancer of the peritoneum is about 4 percent during 20 years from the removal of ovaries and fallopian tubes. We are going to present a case of long lasting diagnosis of pericardial metastases from BRCA1-associated peritoneal cancer.

Successful resection of a huge metastatic liposarcoma in the pericardium resulting in improvement of diastolic heart failure: a case report.

Although liposarcoma often metastasizes to various organs, cardiac metastasis, including to the pericardium, is rare. We present a case of a third recurrence of pericardial metastasis from the thigh, which required surgical resection because of cardiac failure. Surgery was effective for improving cardiac function and reintroducing chemotherapy. This is the first reported case of metastatic pericardial liposarcoma, which was successfully resected three times. We believe that aggressive surgical treatment, when it can resolve cardiac impairment, potentially leads to a more favorable prognosis.

Pericardial Nodular Metastasis from Carcinoma Cervix Uteri

Carcinoma cervix is the second most common cancer in women worldwide and the most common cancer cause of death in the developing countries. In India, it is estimated that approximately 122,844 new cases are diagnosed and 67,477 deaths annually, accounting to nearly 1/3rd of the global cervical cancer deaths. Antemortem diagnosis of isolated metastasis to the pericardium is an uncommonly seen event. Till date few cases only are reported in the literature. We report pericardial nodular metastasis from known carcinoma cervix. Patients with dyspnea in the background of carcinoma cervix usually present with pleural effusion or pulmonary metastasis, but the remote possibility of pericardial metastasis is also to be considered in differential diagnosis.

SMARCB1(INI1)-deficient Sinonasal Basaloid Carcinoma

Poorly differentiated sinonasal carcinomas are a heterogenous group of aggressive neoplasms that encompasses squamous cell carcinoma including basaloid variant, lymphoepithelial carcinoma, sinonasal undifferentiated carcinoma, and neuroendocrine-type small cell carcinoma. We herein describe 3 cases of a hitherto unreported variant combining features of basaloid carcinoma with variable intermingled rhabdoid cells. Patients were 2 women (aged 28 and 35) and a man (52 y) who presented with sinonasal masses. All had advanced local disease with bone involvement (pT4). None had a history of irradiation or a family history of rhabdoid tumors. Treatment was surgery and adjuvant chemoradiation. One patient developed liver, lung, pleural, and pericardial metastases (63 mo) and is currently (70 mo) alive under palliative treatment. Another developed recurrent cervical lymph node metastases and died of disease 8.5 years later. The youngest patient was disease-free at last follow-up 7 years later. Histologic features were very similar in all 3 cases and showed intimate admixture of compact basaloid cell nests with peripheral palisading, perivascular pseudorosettes, and a few scattered rhabdoid cells. Rhabdoid cells were more extensive in the metastasis in 1 case but formed a minor inconspicuous component in the primary tumors in all cases. Striking features common to all cases were (1) basaloid “blue” appearance at low power, (2) papilloma-like exophytic component, (3) extensive pagetoid surface growth with prominent denuding features, and (4) replacement of underlying mucous glands mimicking an inverted papilloma. Clear-cut origin from benign papilloma and overt squamous differentiation were lacking. Diffuse (2) or partial (1) p16 expression was noted, but all cases lacked human papillomavirus DNA by molecular tests. In situ hybridization was negative for Epstein-Barr virus. Immunohistochemistry showed diffuse expression of pancytokeratin. CK5 and vimentin showed intermingling of CK5+/vimentin− basaloid and CK5−/vimentin+ rhabdoid cells. Complete loss of nuclear SMARCB1 expression was seen in all cases including also the denuding carcinoma in situ–like surface lesions. To our knowledge, this variant of sinonasal carcinoma has not been reported before. The identical features in all 3 cases suggest a specific disease rather than a nonspecific dedifferentiated phenotype. Awareness of this rare variant and thus reporting of additional cases is necessary for defining its full morphologic and biological spectrum.

Prognostic factors affecting survival of patients with cancer-related pericardial effusion managed by surgery.

BackgroundAlthough pericardial effusion (PE) is not uncommon in patients with cancer, it may lead to cardiac tamponade, a life-threatening condition. Prompt life-saving treatment is essential, and also allows the continuation of the cancer treatment. The aim of this study was to determine the prognostic factors for survival in patients with cancer who were treated surgically for PE.MethodsWe retrospectively reviewed the medical records of 55 patients with cancer with PE between January 2003 and October 2012, who were treated with a pericardial window operation. Overall survival (OS) was estimated from the date of surgery, and patients were followed until the time of the final visit or time of death. Clinical outcomes and candidate prognostic factors were analyzed.ResultsThe median age of patients was 57 years (range 29 to 82 years), and 31 patients (56.4%) were male. The most common primary malignancy was lung cancer (65.5%), followed by breast cancer (10.9%). Fifteen patients (27.3%) developed recurrence of PE after surgery. The median OS duration was 4 months (range 0 to 39 months). Multivariate analysis found that evidence of pericardial metastasis on preoperative imaging (P = 0.029) and confirmation of malignant cells in the PE and/or pericardial tissue (P = 0.034) were associated with reduced OS.ConclusionEvidence of pericardial metastasis on preoperative imaging and cytopathologic confirmation that the PE and/or pericardial tissue are positive for malignant cells can be used to predict poor clinical outcomes in patients with cancer-related PE.

Imaging of Breast Cancer–Related Changes After Nonsurgical Therapy

The purpose of this article is to review both expected and unexpected thoracic CT manifestations of nonsurgical breast cancer treatment with multimodality imaging correlation. Specific topics include the spectrum of posttherapy changes attributed to chemotherapy and radiation therapy and the spread of breast cancer. Thoracic CT is an important tool commonly used for breast cancer staging and surveillance and for diagnostic indications such as shortness of breath and chest pain. Imaging findings can be related to progression of disease or to associated conditions, such as pulmonary embolism. The hallmarks of breast cancer spread in the thorax include pulmonary nodules, enlarged lymph nodes, pleural effusions, thickening or nodularity, and sclerotic or lytic skeletal lesions. Less common findings including pulmonary lymphangitic tumor spread and pericardial metastasis. The findings also may represent the sequelae of surgery, radiation therapy, or chemotherapy for breast cancer. Knowledge of various treatment methods and their expected and unexpected CT findings is important for recognizing treatment-related abnormalities to avoid confusion with breast cancer spread and thereby minimize the risk that unnecessary further diagnostic imaging will be performed.