METASTATIC ADENOCARCINOMA IN THE PERICARDIUM, WHERE IS THE 'PRIMARY'? A CASE REPORT

Dr. Kurdukar M. D., Dr.Khiste J. A., Dr. Pandit G. A., Dr. Bele T. T.

Abstract


Introduction – Cardiac metastasis is the least explored entity in oncology. Diligent review of literature is found to report cardiac metastasis ranging from 2.3 % to 18.3 %. Cardiac metastasis is commoner than primary cardiac tumours.

Case Report

          Very scant history was available in this medicolegal autopsy of a 55 years male who succumbed to death during travel by a train. Pieces of lungs, liver, spleen, kidneys, brain and heart were received for histopathology. Grossly heart was enlarged with biventricular hypertrophy. Pericardium was thick, opaque, lusterless with adhesions and synechiae. Pericardial space was obliterated with thick yellow exudate. Rest of the received organs were unremarkable.

        Histopathology revealed metastatic adenocarcinoma in pericardium with tumour emboli in lungs.

        Algorithmic immunoprofile showed negativity for CK20,CEA, CDX2,TTF1,Napsin A, Mammoglobin,GCDFP15, Pax8, thyroglobulin, CD 10. Only pan-cytokeratin and CK 27 were expressed by tumour cells.

       Immunohistochemical profile helped to arrive at a diagnosis of possible primary from pancreatobilliary tract.

Discussion-

Rya Nakayama et al noted 74 cases of cardiac metastasis in 466 autopsies representing 17 different types of malignancies. Common primary tumours metastasizing to heart came from breast, lung, oesophagus, pancreas, melanoma and lymphoma.

Conclusion

     The cardiac metastasis from pancreatobilliary tract is the rarest of rare. Searching the primary site of adenocarcinoma needs a rational immunohistochemical algorithm considering the possibility of almost all organs. A panel of useful antibodies with it’s organ sensitivity and specificity is of great value for the accurate diagnosis.


Keywords


Cardiac metastasis, immunoprofile , primary cardiac tumours.

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