2007 OPEN FORUM Abstracts
PERICARDIAL TAMPONADE ASSOCIATED WITH PRIMARY SIGNET RING CELL CARCINOMA OF THE LUNG
V. Subramaniam1, P. Kaplan1, B. Carlin1, D. Dean2
Introduction: We present a unique case of primary signet ring cell carcinoma of lung associated with pericardial tamponade.
Case Presentation: A 73 yr old white man presented with a 6 month history of progressive shortness of breath and leg edema. He had tachycardia and tachypnea and was found to have dullness to percussion and diminished breath sounds bilaterally. He had a systolic murmur radiating to the neck and lower extremity edema. CT Chest showed large bilateral pleural effusions and a thoracentesis was performed which showed cells suspicious for malignancy and an elevated CEA of 428. An echocardiogram showed a large pericardial effusion with tamponade physiology. The cytology from an emergent pericardiocentesis was consistent with signet ring cell carcinoma. He then underwent lung, pleural, and pericardial biopsies in addition to a pericardial window. Immunohistochemistry analysis of the biopsies was consistent with signet ring cell carcinoma of the lung (CEA, CK7 and TTF-1 positive.)
Discussion: Primary signet ring cell carcinoma (SRCC) of the lung has a reported incidence of 1.5%, but pericardial involvement has not been previously reported. The most common form of pulmonary and pericardial SRCC is metastasis from GI primary with a five year survival rate of SRCC of the lung has been reported as low as 28.4%. In this instance, the development of a pericardial effusion in association with a pleural effusion suggested the presence of a malignancy. Further diagnostic measures showed the presence of a primary signet ring cell carcinoma.
Conclusion: This case represents a unique case of pericardial effusion and associated tamponade secondary to a primary signet ring cell carcinoma of the lung