Maisch B, Burchert A, Moll R, Pankuweit S
Department of Internal Medicine and Cardiology, University Hospital Gießen and Marburg (UKGM GmbH) and Philipps University Marburg, Deutschland.
Herz. 2011 Jun;36(4):352-4. doi: 10.1007/s00059-011-3479-7.
The pathology underlying a pericardial effusion in a 24-year-old patient, who had suffered from acute myeloic leukemia 5 years previously and undergone chemotherapy followed by whole body radiation prior to allogeneic stem cell transplantation, could be identified by the careful analysis of pericardial cytology and epicardial biopsy guided by flexible pericardioscopy. Molecular, histological, cytochemical and immunological examination of the effusion and the epicardial biopsy for a viral or bacterial infection despite known CMV reactivation, or an effusion induced by radiation or graft-versus-host reaction, could be ruled out as possible causes of pericardial tamponade. The infiltration of CD 117-positive cells in the biopsied cardiac tissue revealed recurrent acute myeloic leukemia now also affecting the heart and the pericardium. An intrapericardial instillation of 1000 mg triamcinolone acetate at day 1 and 50 mg/m(2) cisplatin at day 3 effectively prevented the recurrence of tamponade, but could not prevent a lethal outcome 3 weeks later.
一名24岁患者出现心包积液，该患者5年前曾患急性髓性白血病，在异基因干细胞移植前接受了化疗及全身放疗。通过在可弯曲心包镜引导下仔细分析心包细胞学检查及心外膜活检，可明确其病理情况。尽管已知巨细胞病毒再激活，但对积液及心外膜活检进行分子、组织学、细胞化学及免疫学检查，以排查病毒或细菌感染，或由放疗或移植物抗宿主反应引起的积液，这些均被排除作为心包填塞的可能原因。活检心脏组织中CD 117阳性细胞浸润提示急性髓性白血病复发，现累及心脏和心包。在第1天心包内注入1000 mg醋酸曲安奈德，第3天注入50 mg/m²顺铂，有效预防了心包填塞复发，但3周后未能避免致命结局。
