Platinum sensitive carcinoma of ovary relapsed as pericardial effusion with cardiac tamponade

Abstract

Epithelial ovarian cancers typically spread by intraperitoneal exfoliation and retroperitoneal lymph nodal involvement along the ovarian vascular supply. Pericardial involvement in ovarian malignancies is very rare with only few cases reported in the literature. Malignancy is the most common cause for pericardial effusion in the western world. In this case report, we present a 58-year-old woman treated for high-grade serous carcinoma of the ovary in 2010, relapsed with pericardial effusion and cardiac tamponade in 2017. Imaging studies revealed gross pericardial effusion. Two-dimensional echocardiogram showed massive pericardial effusion, with cardiac tamponade, New York Heart Association-IV. Pericardiocentesis and pigtail drain was placed under echo guidance. Immunocytochemistry has confirmed the tumour cells to be of the ovarian origin. The patient underwent surgical pericardial window via thoracotomy, followed by paclitaxel and carboplatin-based chemotherapy and olaparib maintenance.

Keywords: cancer - see oncology; chemotherapy; gynecological cancer.

Figure 1

Chest X-ray posteroanterior view showing increased cardiothoracic ratio without pulmonary congestion.

Figure 2

Contrast-enhanced CT axial section showing gross pericardial effusion, mild bilateral pleural effusion.

Figure 3

Contrast-enhanced CT coronal section showing gross pericardial effusion.

Figure 4

H&E stained section (A) (400× magnification) showing atypical cell clusters in the pericardial wall. These cells show marked nuclear pleomorphism with coarse chromatin, prominent nucleoli and scant pale eosinophilic cytoplasm. On immunocytochemistry these cells are positive for antibodies against PAX8 (B) (intense and nuclear), cytokeratin 7 (C) (intense and cytoplasmic), WT1 (D) (focal and nuclear), p53 (E) (intense and nuclear) and ER (F) (pale and nuclear) while being negative for PR (G).