title: [A case of recurring breast cancer causing pericardial metastasis showing a good response following local treatment with methotrexate].
abstract: A 52-year-old woman was admitted with a chief complaint of dyspnea. She had undergone right mastectomy for Stage IIB breast cancer 2 years and five months earlier. Chest roentgenogram revealed cardiomegaly and bilateral pleural effusion, and a cardiac echogram showed marked retention of pericardial effusion. A diagnosis of cardiac tamponade was made and pericardiocentesis for continuous drainage was carried out cytologically, the effusion was class V and showed evidence of pericardial metastasis of breast cancer. Pericardiocentesis followed by methotrexate instillation 6 times in a dose of 110 mg successfully controlled the cardiac tamponade, after which the catheter could be removed from the pericardial space. Systemic chemotherapy (CEF) was started at the same time. The patient was discharged very much improved after these treatments, but she died of brain metastasis after 9 months. This case suggests that intrapericardial application of methotrexate may be very useful in the management of carcinomatous cardiac tamponade without any serious side effects.
authors.affiliation: Dept. of Surgery, Suita Municipal Hospital.
authors.forename: K
authors.initials: K
authors.lastname: Nakaguchi
authors.forename: J
authors.initials: J
authors.lastname: Furukawa
authors.forename: N
authors.initials: N
authors.lastname: Maruyama
authors.forename: M
authors.initials: M
authors.lastname: Nakamura
authors.forename: T
authors.initials: T
authors.lastname: Shingai
authors.forename: K
authors.initials: K
authors.lastname: Maruyama
authors.forename: Y
authors.initials: Y
authors.lastname: Katsumoto
authors.forename: S
authors.initials: S
authors.lastname: Okajima
authors.forename: F
authors.initials: F
authors.lastname: Sue
authors.forename: W
authors.initials: W
authors.lastname: Yoshiwara
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000150:complications / Q000473:pathology*; D002305:Cardiac Tamponade / Q000209:etiology; D003520:Cyclophosphamide / Q000008:administration & dosage; D004322:Drainage; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006338:Heart Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology / Q000628:therapy
chemical_list: D000964:Antimetabolites, Antineoplastic; D015251:Epirubicin; D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate