Edoute Y, Kuten A, Ben-Haim S A, Moscovitz M, Malberger E
Department of Internal Medicine, Rambam Medical Center, Haifa, Israel.
J Surg Oncol. 1990 Dec;45(4):265-9. doi: 10.1002/jso.2930450411.
Clinical and cytologic findings in 21 breast cancer patients with symptomatic pericardial effusion are presented. The etiology of the pericardial effusion was definitely malignant, by cytology/histology in 13 patients (62%), and suspected malignant by cytology in 2 patients (9%). One patient (5%) with definitely nonmalignant pericardial effusion by cytology was found to be histologically positive at autopsy. In 5 patients (24%) there was no histological/cytological evidence of malignancy; radiation pericarditis could be the etiology in 4 of these 5 patients. The median time from the diagnosis of breast cancer to the development of symptomatic pericardial effusion was 60 months (range: 1-219 months). Ten patients developed cardiac tamponade; they were treated by either pericardiocentesis or pericardiectomy. The mean survival of patients with negative cytology/histology was 12 months; patients with suspicious cytology had a mean survival of 9 months; patients with malignant effusion, treated by pericardiectomy, had a mean survival of 22.3 months, while patients with malignant pericardial effusion, who were not subjected to surgery, had a mean survival of 4.7 months, only. It is concluded that the etiology of symptomatic pericardial effusion in breast cancer patients is not always malignant, which emphasizes the role of fluid cytology in establishing definite diagnosis. The survival probability is a function of the extent of extracardiac disease; among patients with malignant pericardial effusion those selected for pericardiectomy have a longer than average survival.
本文介绍了21例有症状性心包积液的乳腺癌患者的临床和细胞学检查结果。心包积液的病因经细胞学/组织学检查确定为恶性的有13例患者（62%），经细胞学检查怀疑为恶性的有2例患者（9%）。1例经细胞学检查确定为非恶性心包积液的患者在尸检时发现组织学检查呈阳性。5例患者（24%）没有恶性肿瘤的组织学/细胞学证据；这5例患者中有4例的病因可能是放射性心包炎。从乳腺癌诊断到出现症状性心包积液的中位时间为60个月（范围：1 - 219个月）。10例患者发生了心脏压塞；他们接受了心包穿刺术或心包切除术治疗。细胞学/组织学检查阴性的患者平均生存期为12个月；细胞学检查可疑的患者平均生存期为9个月；接受心包切除术治疗的恶性积液患者平均生存期为22.3个月，而未接受手术的恶性心包积液患者平均生存期仅为4.7个月。结论是，乳腺癌患者有症状性心包积液的病因并不总是恶性的，这强调了液体细胞学在明确诊断中的作用。生存概率是心外疾病范围的函数；在恶性心包积液患者中，选择进行心包切除术的患者生存期长于平均水平。
