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The causes of pericardial effusion include acute pericarditis, autoimmune disease, post-myocardial infarction, cardiac surgery, malignancy, and renal failure. Malignant involvement of the pericardium is common among patients with cancer (
).
The etiology of pericardial involvement in cancer may be complicated. Cancer-related pericardial effusion occurs as a primary cancer, as a secondary metastasis from a noncardiac primary tumor, or as an adverse effect of chemotherapy and/or radiotherapy (
). Secondary pericardial effusion occurs more frequently than primary pericardial effusion does. Any cancer can affect the pericardium, and typical secondary tumors that invade the pericardium include lung cancer, breast cancer, and lymphoma or leukemia (
,
). In this issue of Internal Medicine, Yamakawa et al. (
) present a rare case of a directly invasive thymoma causing cardiac tamponade.
Pericardial effusions may develop either acutely or chronically. If they are chronic effusions, the pericardium can be stretched to grow accustomed to elevations in pericardial volume. If the pericardial volume develops acutely, intrapericardial pressure increases and may cause cardiac tamponade, which requires emergency treatment. The management of neoplastic pericardial effusions depends on several factors, including the severity of symptoms, type of malignancy, and life expectancy. Pericardiocentesis is indicated for cardiac tamponade to relieve symptoms and establish a diagnosis of neoplastic cardiac tamponade (
). A definitive diagnosis can only be made by confirming pathological findings. A previous study reported that the sensitivity of pericardial cytology is 75% (
). A multidisciplinary team of experts in cardiac oncology, radiation oncology, and thoracic surgery should explore therapeutic interventions.
The most common type of anterior mediastinal tumor is a thymoma. Symptoms of thymoma may be 1) asymptomatic, 2) due to tumor invasion, or 3) associated with paraneoplastic syndromes (
). Thymomas are usually confined to the thymus gland and cause chest symptoms, such as pain, cough, and dyspnea. Paraneoplastic syndromes include myasthenia gravis (MG), pure red cell aplasia, and immunodeficiency. In this case report, cardiac tamponade due to tumor invasion was the initial presentation (
).
The management and prognosis of thymoma depend on complete resectability, the stage of the disease, and the histological type (
). Complete surgical resection is indicated as the initial treatment for resectable tumors. Chemotherapy and radiation therapy can be considered due to additional information on the pathology following surgery. Neoadjuvant chemotherapy may be recommended as the initial treatment for patients with locally advanced but potentially resectable thymoma. If the response to chemotherapy is acceptable, surgical interventions will be considred as treatment options. Radiation therapy, chemoradiotherapy, or combination therapy may be appropriate for patients presenting with unresectable and extensive thymoma.
In this issue of Internal Medicine, Yamakawa et al. (
) described a rare case of cardiac tamponade due to advanced thymoma, showing a rare initial manifestation of thymoma. The patient showed the first symptoms of cardiac tamponade due to cancer invasion of the pericardium. They underwent surgical resection and pericardial fenestration and were diagnosed with type AB thymoma based on the histological findings of pericardiocentesis. Thymomas should therefore be considered in the differential diagnosis of neoplastic cardiac tamponade.
The authors state that they have no Conflict of Interest (COI).
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