Adenocarcinoma arising in a Ghon complex and presenting with massive pericardial effusion

Our plain-English summary of Adenocarcinoma arising in a Ghon complex and presenting with massive pericardial effusion, by R.R. McFadden, P.J. Dawson (Chest, 1972).

The study

• Authors: R.R. McFadden, P.J. Dawson
• Journal: Chest
• Published: 1972;62(4):520-3
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A patient with carcinoma arising in the peripheral scar of a Ghon complex is reported. The tumor had an unusual presentation, suggestive of pericardial mesothelioma. The smallness of the primary lesion, its rapidly fatal course, superimposed consumption coagulopathy and histologic difficulties in diagnosis of the original biopsy add to the interest and complexity of the case.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This case report described one patient, a 33-year-old white woman who had smoked two to three packs of cigarettes a day. The article does not mention asbestos. In 1970 she developed bloody fluid around the heart (a pericardial effusion). Tests of the fluid found no cancer cells, and the fluid kept returning. Tissue removed from the pericardium showed a poorly differentiated malignant tumor. The authors said this unusual presentation suggested pericardial mesothelioma. She developed widespread blood clotting and died in early July after an illness of less than six months. At autopsy, the authors found a 1 cm nodule at the top of the right lung. An adenocarcinoma had grown in and around an old scar there (a Ghon complex) and had spread to lymph nodes and the pericardium. The authors listed features that should have pointed away from mesothelioma: a normal lining over the tumor, extensive spread through lymph vessels, no cancer cells in the fluid, and mucin in tumor cells but not in lining cells. The cause of the scar was unknown. The authors found no earlier report of a scar cancer presenting with pericardial effusion.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient, including autopsy findings)
• Who was studied: One patient: a 33-year-old white woman whose illness began in 1970. She was treated at the authors' hospital, and the authors were in the Department of Pathology, University of Oregon Medical School, Portland.
• Exposure: No asbestos exposure is reported. The patient smoked two to three packs of cigarettes per day, for an unspecified length of time. The lung cancer arose in an old scar (Ghon complex) of unknown cause.
• Main results:
  • The authors described the tumor's presentation as unusual and suggestive of pericardial mesothelioma.
  • The pericardial effusion recurred. Cytologic examination and culture of the fluid were negative again.
  • The pericardectomy specimen contained malignant tumor cells, singly and in small clusters, in the pericardium's fibrous tissue and lymphatics.
  • Tests were consistent with diffuse intravascular coagulation, a widespread clotting disorder.
  • The patient died in early July after a total illness of less than six months.
  • At autopsy, there was a 1 cm firm nodule at the apex of the right lung, with a malignant tumor within and surrounding the scar.
  • The hilar, mediastinal and pancreatic lymph nodes were extensively replaced by tumor.
  • In retrospect, the authors identified histologic features that should have led away from a diagnosis of primary mesothelioma. These included a normal mesothelial surface over the tumor, extensive lymphatic spread, and no malignant cells in the pericardial fluid.
  • Mucin was found in some tumor cells, but the mesothelial cells were mucin negative.
  • The authors found no report in the literature of a scar cancer presenting with pericardial effusion.
• The authors' conclusion: The authors noted that pathologists have paid less attention to minute peripheral lung nodules than to the major bronchi when looking for hidden primary tumors at autopsy.
• Limitations the authors state:
  • The cause of the scar was unknown.
  • Tuberculosis was not confirmed, because neither mycobacteria nor fungi were demonstrated. Skin tests for histoplasmosis and coccidioidomycosis were not performed.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Adenocarcinoma, Pericardial Effusion, Carcinoma, Pericardial Mesothelioma, Biopsy.

Related studies

• Cytological differential diagnosis among adenocarcinoma, epithelial mesothelioma, and reactive mesothelial cells in serous effusions by immunocytochemistry — X.Y. Su, G.D. Li, et al. (2011)
• Utility of HBME-1 immunostaining in serous effusions — V. Ascoli, C. Carnovale-Scalzo, et al. (1997)
• Pericardial mesothelioma masquerading as a benign pericardial effusion — N.L. Coplan, A.J. Kennish, et al. (1984)
• Ber-EP4 for differentiating adenocarcinoma from reactive and neoplastic mesothelial cells in serous effusions. Comparison with carcinoembryonic antigen, B72.3 and Leu-M1 — M.E. Bailey, R.W. Brown, et al. (1996)
• Ancillary studies in pleural, pericardial, and peritoneal effusion cytology — K.E. Sundling, E.S. Cibas (2018)
• Tetracycline sclerosis in the management of malignant pericardial effusion — F.A. Shepherd, J.S. Ginsberg, et al. (1985)

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