The Science Journal of the American Association for Respiratory Care

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

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