Diagnosis of Cardiac Metastasis on Pericardial Fluid Cytology in a Patient of Urothelial Carcinoma of Bladder: A Case Report
ED04-ED06
Correspondence
Dr. Ramnik Singh,
Resident, Department of Pathology, Krishna Vishwa Vidyapeeth, Karad-415103, Maharashtra, India.
E-mail: ramniksingh1995@gmail.com
Bladder cancer ranks as the 9th most common malignancy worldwide within the urinary system. Urothelial carcinoma stands as the predominant histologic type in the United States and Western Europe, constituting approximately 90% of bladder cancer cases. While common sites of metastasis for urothelial carcinoma typically involve regional and distinct lymph nodes, the liver, lungs, and bones, instances of metastasis to the pericardium are rare. Roughly 10% of urothelial carcinoma cases exhibit cardiac metastasis, often remaining clinically asymptomatic. Hereby, the authors present a rare case of symptomatic pericardial infiltration originating from urothelial carcinoma in a 32-year-old male. The patient initially presented with a two-week history of progressive dyspnoea on exertion and had been previously diagnosed with high-grade transitional cell carcinoma with squamous differentiation upon histopathological examination and urothelial carcinoma on a Positron Emission Tomography (PET) scan 12 months earlier. Following neoadjuvant chemotherapy and radiotherapy, the patient exhibited a partial response to the treatment. However, despite the effectiveness of the therapies, he developed dyspnoea and pericardial effusion. Although pericardial involvement in advanced malignancies is not uncommon, symptomatic cardiac metastasis from urothelial carcinoma remains rare. Radiographic studies revealed right-sided pleural effusion, while a Computed Tomography (CT) scan of the thorax and upper abdomen (plain and contrast) displayed severe bilateral pleural effusion, pericardial effusion, and metastatic deposits in the mediastinal lymph nodes. Electrocardiography indicated sinus tachycardia, inverted T-waves in leads V1 to V5, and flattening of the T-wave in V6. The patient underwent pericardial tapping, yielding approximately 50 cc of pericardial fluid. A 10 cc of the pericardial fluid was subsequently sent for examination in the Pathology Department, with fluid cytology results indicating the presence of malignant cells.