Update on diagnosis and management of neoplastic pericardial disease

ABSTRACT

Introduction

Pericardial neoplasms are uncommon, mostly due to secondary involvement of the pericardium by extracardiac tumors. Clinical presentation is nonspecific, frequently leading to a delayed diagnosis. Moreover, both benign and malignant pericardial tumors may be associated with myocardial infiltration and mechanical compression of cardiac chambers, possibly precipitating clinical conditions. Pericardial tumors are indeed a diagnostic and therapeutic clinical challenge.

Areas covered

This review aims to provide an overview of the main clinical characteristics of pericardial tumors, along with their management in clinical practice.

Expert commentary

Multimodality imaging (echocardiography, chest X-ray, CT, CMR, and PET) enable full characterization of pericardial neoplasms. An individualized strategy should be developed by a multidisciplinary team including cardiologists, oncologists, radiologists, and cardiac surgeons.

KEYWORDS:

• Pericardium
• mass
• tumor
• neoplastic
• effusion

Article highlights

1. Pericardial tumors are rare entities with a challenging diagnosis, due to nonspecific clinical presentation.

2. Metastatic tumors of the pericardium are far more frequent than primary tumors.

3. Multimodality imaging not only enables a full characterization of pericardial masses, but is critical to guide treatment choice.

4. Immunohistochemistry, biomarkers (especially CEA and CYFRA 21-1) and microRNA analysis provides useful diagnostic information.

5. A patient-tailored treatment, developed by a multidisciplinary team including cardiologists, oncologists, radiologists and cardiac surgeons is strongly advocated.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.