Neoplastic Pericardial Disease

Malignant pericardial disease represents a common cause of morbidity and mortality in patients with cancer. Malignant tumours of the pericardium may occur as primary or secondary tumours. Primary tumours of the pericardium occur rarely, and secondary involvement of the pericardium constitutes the majority of the cases of malignant disease of the pericardium. In necropsy series, the pericardium is involved in 5 to 40% of patients with malignant disease (1-3). Autopsy studies overestimate the clinical problem because they mostly include terminally ill patients and also identify microscopic metastases even without pericardial effusion. For the majority of patients, a clinical manifestation of neoplastic pericarditis is absent or remains unrecognised during their lifetime. In a study comparing clinical and pathologic features of pericardial metastases, 60%-70% were clinically non significant (4). Clinically, neoplastic pericarditis presents itself as acute pericarditis, pericardial effusion, effusive-constrictive pericarditis or cardiac tamponade (5). In their retrospective analysis from the years 1979 to 2000, the Mayo Clinic reported a decrease of the prevalence of cancer among symptomatic pericardial effusion, mainly due to an increase of pericardial effusion due to postoperative procedures or perforations from invasive procedures, rather than to a decrease of malignant pericarditis cases (6). A Spanish study observing the years 1998-2002 and an Italian study observing the years 1996-2003, report a neoplastic etiology among pericardial effusion in 13% and 7.3%, respectively (7,8). The relative proportions of neoplastic pericarditis in particular population depends on the prevalence of cancer and the prevalence of other causes of effusion in particular populations.