title: A case with cardiac tamponade as the first sign of primary gastric signet-ring cell carcinoma treated with combination therapy.
abstract: BACKGROUND
  This report presents a rare patient with cardiac tamponade as the first manifestation of primary gastric signet-ring cell carcinoma.
  
  
  METHODS
  A 56-year-old woman with emergent dyspnea, anterior chest oppression, and hypotension was diagnosed as having cardiac tamponade due to massive pericardial effusion. The endoscopic examination of the stomach disclosed gastric cancer in the posterior wall of the antrum and the biopsy showed signet-ring cell carcinoma. The gastric cancer was complicated by malignant pericardial effusion and pleural effusion as well as metastasis to the peripheral lymph nodes and bones. The patient was treated with percutaneous pericardiocentesis followed by systemic chemotherapy (oxaliplatin and sequential 5-fluorouracil plus leucovorin). The pericardial effusion gradually disappeared and there was no cardiac tamponade occurrence. The patient has survived more than 6 months so far.
  
  
  CONCLUSIONS
  Cardiac tamponade may originate from a primary gastric signet-ring cell carcinoma. Pericardiocentesis followed by systemic chemotherapy may be effective in controlling such advanced gastric signet-ring cell carcinoma.
authors.affiliation: Department of Cardiology, Affiliated Changhai Hospital of the Second Military Medical University, Shanghai, 200433, China.
authors.forename: Bi-li
authors.initials: BL
authors.lastname: Zhang
authors.forename: Rong-liang
authors.initials: RL
authors.lastname: Xu
authors.forename: Xing
authors.initials: X
authors.lastname: Zheng
authors.forename: Yong-wen
authors.initials: YW
authors.lastname: Qin
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018279:Carcinoma, Signet Ring Cell / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002305:Cardiac Tamponade / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011859:Radiography; D013274:Stomach Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D002955:Leucovorin; D005472:Fluorouracil