Malignant Pericardial Tamponade Secondary to Ovarian Clear Cell Carcinoma

Abstract

Malignant pericardial effusion is an uncommon metastatic manifestation of ovarian carcinoma. Few cases of ovarian serous carcinoma have been previously reported. Ovarian clear cell carcinoma is the second most common histologic subtype in East Asian countries and is a relatively rare in Western countries. Here, we report the case of cardiac tamponade secondary to Ovarian clear cell carcinoma. A 46-year-old woman with recurrent Ovarian clear cell carcinoma presented with worsening cough, palpitations, and shortness of breath during chemotherapy. Chest radiography and computed tomography confirmed a pleural effusion with cardiac tamponade. The patient underwent pericardial fenestration and drainage for cardiac tamponade. Pericardial fluid cytology showed malignant cells forming papillary and ball-like clusters with irregular stacking. The cells had a mirror ball-like appearance and collagenous stroma, in which a homogenous hyaline core was observed in the center of most tumor cell clusters. Based on these findings, a diagnosis of Ovarian clear cell carcinoma metastasis was made. She received palliative care and died 5 months after the operation without recurrent cardiac tamponade. This case suggests that cytological findings from pericardial effusion are useful in diagnosing Ovarian clear cell carcinoma metastasis.

Keywords: cardiac tamponade; clear cell carcinoma; cytology; ovarian carcinoma; pericardial effusion.

Fig. 1.

Chest radiograph showing an enlarged heart caused by pericardial effusion at the time of admission. (A) Chest radiograph; (B) Computed tomography scan.

Fig. 2.

Cytologic findings from pericardial effusion of ovarian clear cell carcinoma. (A) Malignant cells were partially found in papillary and ball-like clusters with irregular stacking. Papanicolaou. Bar = 100 μm. (B) The cells showed a mirror ball-like appearance. Papanicolaou. Bar = 10 μm. (C) The cells consisted of collagenous stroma with a homogenous hyaline core that was observed in the center of most tumor cell clusters. Papanicolaou. Bar = 10 μm.

Fig. 3.

Chest radiographs. (A) Scan taken immediately after pericardial fenestration and pericardial drainage. ▲indicates the drainange tube. (B) Two months later.