Benjamin Lardinois, Jean-Charles Goeminne, Laurence Miller, Adrien Randazzo, Terry Laurent, Régis Debois
Laboratory Department, CHU UCL Namur Site de Sainte-Elisabeth, Université catholique de Louvain, Namur, Belgium.
Oncology Department, CHU UCL Namur Site de Sainte-Elisabeth, Université catholique de Louvain, Namur, Belgium.
SAGE Open Med Case Rep. 2021 Jul 28;9:2050313X211036005. doi: 10.1177/2050313X211036005. eCollection 2021.
Immune-related adverse events including cardiac toxicity are increasingly described in patients receiving immune checkpoint inhibitors. We described a malignant pericardial effusion complicated by a cardiac tamponade in an advanced non-small cell lung cancer patient who had received five infusions of atezolizumab, a PDL-1 monoclonal antibody, in combination with cabozantinib. The definitive diagnosis was quickly made by cytology examination showing typical cell abnormalities and high fluorescence cell information provided by the hematology analyzer. The administration of atezolizumab and cabozantinib was temporarily discontinued due to cardiogenic hepatic failure following cardiac tamponade. After the re-initiation of the treatment, pericardial effusion relapsed. In this patient, the analysis of the pericardial fluid led to the final diagnosis of pericardial tumor progression. This was afterwards confirmed by the finding of proliferating intrapericardial tissue by computed tomography scan and ultrasound. This report emphasizes the value of cytology analysis performed in a hematology laboratory as an accurate and immediate tool for malignancy detection in pericardial effusions.
在接受免疫检查点抑制剂治疗的患者中，包括心脏毒性在内的免疫相关不良事件越来越多地被报道。我们描述了一名晚期非小细胞肺癌患者，在接受了5次阿替利珠单抗（一种PDL-1单克隆抗体）联合卡博替尼输注后，出现了恶性心包积液并伴有心脏压塞。通过细胞学检查发现典型的细胞异常以及血液分析仪提供的高荧光细胞信息，迅速做出了明确诊断。由于心脏压塞后出现心源性肝衰竭，阿替利珠单抗和卡博替尼的给药暂时中断。重新开始治疗后，心包积液复发。对该患者心包积液的分析最终诊断为心包肿瘤进展。随后通过计算机断层扫描和超声发现心包内组织增生得到了证实。本报告强调了在血液学实验室进行细胞学分析作为检测心包积液中恶性肿瘤的准确且即时工具的价值。
