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Peer-reviewedCC BY 4.0Cancers

Occult Malignancy Presenting as Pericardial Effusion: The Diagnostic Contribution of Pericardial Fluid Cytology

  • Iulia Raluca Munteanu1,2,3
  • Ramona Cristina Novaconi2
  • Radu Ioan Lala4,5
  • Caius Glad Streian2,6
  • Ciprian Nicușor Dima2,6
  • Adrian Petru Merce2
  • Lucian Silviu Falniță2,3
  • Marinela-Adela Scuturoiu3,7
  • Adrian-Grigore Merce1,2,3
  • Alina Gabriela Negru8
  • Horea Bogdan Feier2,3,6
8 affiliations
  1. 1Doctoral School Medicine-Pharmacy, “Victor Babes” University of Medicine and Pharmacy Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania
  2. 2Clinic of Cardiovascular Surgery, Institute for Cardiovascular Diseases of Timisoara, Gheorghe Adam Street, No. 13A, 300310 Timisoara, Romania
  3. 3Advanced Research Center, Institute for Cardiovascular Diseases, 300310 Timisoara, Romania
  4. 4Multidisciplinary Doctoral School, Vasile Goldis Western University of Arad, 310025 Arad, Romania
  5. 5Victor Babes Clinical Hospital for Infectious Diseases and Pneumology of Timisoara, 300041 Timisoara, Romania
  6. 6Department VI Cardiology, Cardiovascular Surgery Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania
  7. 7NEUROPSY-COG Center for Cognitive Research in Neuropsychiatric Pathology, Department of Neuroscience, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
  8. 8Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Sq. No. 2, 300041 Timisoara, Romania
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Abstract

Background/Objectives: Pericardial effusion may occur in patients with established cancer but may also represent the first manifestation of an occult malignancy. This study evaluated the diagnostic contribution of pericardial fluid cytology and pathological assessment according to previous oncological status, with particular emphasis on previously unrecognized malignancy. Methods: We conducted a retrospective observational study of patients hospitalized with pericardial disease between January 2021 and December 2025 at a tertiary cardiovascular center. The final cohort comprised 234 clinical episodes in 209 patients. Clinical, laboratory, imaging, procedural, cytological, and histopathological data were analyzed in relation to previous oncological status and malignant pericardial involvement. Results: Pathological assessment was available in 95/234 episodes (40.6%), with neoplastic involvement identified in 21/95 (22.1%). Neoplastic findings occurred in 13/33 (39.4%) evaluable episodes with known malignancy and 8/62 (12.9%) without a previous cancer diagnosis (odds ratio, 4.39; 95% confidence interval, 1.59–12.11; p = 0.004). Conversely, 20/33 (60.6%) evaluable episodes in patients with known cancer showed no neoplastic involvement. In all eight patients without previously known malignancy, pericardial fluid cytology provided the first pathological evidence of cancer; six (75%) had findings suggestive of a pulmonary origin. All presented with large effusions and hemodynamic compromise. Conclusions: Pericardial pathological assessment provides diagnostic information beyond previous oncological status. It can distinguish malignant from non-neoplastic pericardial involvement in patients with established cancer while also revealing occult malignancy when pericardial disease is its first presentation.

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Cite

BibTeXRIS
BibTeX
@article{munteanu2026occult,
  title = {{Occult Malignancy Presenting as Pericardial Effusion: The Diagnostic Contribution of Pericardial Fluid Cytology}},
  author = {Iulia Raluca Munteanu and Ramona Cristina Novaconi and Radu Ioan Lala and Caius Glad Streian and Ciprian Nicușor Dima and Adrian Petru Merce and Lucian Silviu Falniță and Marinela-Adela Scuturoiu and Adrian-Grigore Merce and Alina Gabriela Negru and Horea Bogdan Feier},
  journal = {Cancers},
  year = {2026},
  month = oct,
  doi = {10.3390/cancers18203368},
  url = {https://www.mdpi.com/2072-6694/18/20/3368},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Occult Malignancy Presenting as Pericardial Effusion: The Diagnostic Contribution of Pericardial Fluid Cytology
AU  - Iulia Raluca Munteanu
AU  - Ramona Cristina Novaconi
AU  - Radu Ioan Lala
AU  - Caius Glad Streian
AU  - Ciprian Nicușor Dima
AU  - Adrian Petru Merce
AU  - Lucian Silviu Falniță
AU  - Marinela-Adela Scuturoiu
AU  - Adrian-Grigore Merce
AU  - Alina Gabriela Negru
AU  - Horea Bogdan Feier
PY  - 2026
DA  - 2026/10/01
JO  - Cancers
DO  - 10.3390/cancers18203368
UR  - https://www.mdpi.com/2072-6694/18/20/3368
AB  - Background/Objectives: Pericardial effusion may occur in patients with established cancer but may also represent the first manifestation of an occult malignancy. This study evaluated the diagnostic contribution of pericardial fluid cytology and pathological assessment according to previous oncological status, with particular emphasis on previously unrecognized malignancy. Methods: We conducted a retrospective observational study of patients hospitalized with pericardial disease between January 2021 and December 2025 at a tertiary cardiovascular center. The final cohort comprised 234 clinical episodes in 209 patients. Clinical, laboratory, imaging, procedural, cytological, and histopathological data were analyzed in relation to previous oncological status and malignant pericardial involvement. Results: Pathological assessment was available in 95/234 episodes (40.6%), with neoplastic involvement identified in 21/95 (22.1%). Neoplastic findings occurred in 13/33 (39.4%) evaluable episodes with known malignancy and 8/62 (12.9%) without a previous cancer diagnosis (odds ratio, 4.39; 95% confidence interval, 1.59–12.11; p = 0.004). Conversely, 20/33 (60.6%) evaluable episodes in patients with known cancer showed no neoplastic involvement. In all eight patients without previously known malignancy, pericardial fluid cytology provided the first pathological evidence of cancer; six (75%) had findings suggestive of a pulmonary origin. All presented with large effusions and hemodynamic compromise. Conclusions: Pericardial pathological assessment provides diagnostic information beyond previous oncological status. It can distinguish malignant from non-neoplastic pericardial involvement in patients with established cancer while also revealing occult malignancy when pericardial disease is its first presentation.
SN  - 2072-6694
ER  -