[Women and pericardial neoplastic manifestations of the heart and pericardium].
BACKGROUND
In every year since 1984, cardiovascular disease has claimed the lives of more females than males. In the Western world more than 450,000 women succumb to heart disease annually. Despite the proportions, most women believe that heart disease is a man's disease and that they will die of breast cancer. Data on epidemiology and incidence are rare: there is only an estimated incidence of cardiac neoplasm at necropsy ranging from 0,001% to 0,3%. The majority of the primary tumors are benign. Females are affected more often than males. The most common tumor entity is benign cardiac myxoma. Malignant heart tumors are less common. Most often they are different types of sarcomas, which have a poor outcome and affect more males than females. Metastatic tumors of the heart are 100 times more common than the primary ones. They originate mainly from melanomas, leukemias, lymphomas, and cancer, especially of the lung or breast. Indeed in women breast cancer is the most common metastatic tumor associated with pericardial effusion. To prevent death from tamponade, pericardiocentesis, in addition to the systemic chemotherapy, is mandatory, best when instillation of chemotherapeutics (cisplatin or thiotepa) or radioisotopes is given into the pericardial sac to prevent recurrence of the effusion. However, more of the malignant tumors may be curable if exactly diagnosed at an earlier stage.


METHODS
A retrospective study was conducted of all patients with cardiac and pericardial neoplasm exactly diagnosed by endomyocardial or epicardial biopsy and pericardiocentesis, using hospital medical records and a biopsy and pericardiocentesis registry from 2000-2005 with 297 patients. Pericardial effusion and biopsy analyses included biochemistry, cytology, serology, microbiology, histology, immunohistology, and polymerase chain reaction (PCR). All patients were investigated in relation to Herzmetasgender differences to histopathologic findings, clinical presentation and outcome.


RESULTS
In 76 cases (25.6%) a neoplasm was the reason for a pericardial effusion. 36 women suffered from the breast carcinoma (47%) and 40 males lung cancer (42%) as the firstly metastatic tumor. There was no recurrence of a relevant pericardial effusion in patients who were treated by intrapericardial instillation of cisplatin (30 mg/m2 body surface in 100 ml 0.9% NaCl).


CONCLUSIONS
Females are more often affected by primary cardiac tumors than males with an excellent outcome. By contrast, the preventive checkup and aftercare will gain more prognostic importance, especially in case of breast cancer, to earlier recognize a secondary cardiac neoplasm by biopsy and pericardiocentesis with intrapericardial treatment of neoplastic pericarditis.
Kisselbach
Christiane
C
Klinik für Innere Medizin -- Kardiologie, Philipps- Universität Marburg, Marburg.
Ristic
Arsen D
AD
Pankuweit
Sabine
S
Karatolius
Konstantinos
K
Maisch
Bernhard
B
D001943:Breast Neoplasms / Q000453:epidemiology* / Q000556:secondary*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006338:Heart Neoplasms / Q000453:epidemiology* / Q000556:secondary*; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D016387:Women's Health