METASTATIC SQUAMOUS-CELL CARCINOMA IN PERICARDIAL-EFFUSION - REPORT OF 4 CASES, 2 WITH CARDIAC-TAMPONADE

For reasons unknown metastatic squamous-cell carcinoma is a rare cause of pleural effusions and is even less common in pericardial effusions . A review of all pericardial effusions examined in the Cytology Servi ce at Montefiore Medical Center over a 15-year (1980-1994) period was undertaken (N = 251). Four cases with metastatic squamous-cell carcino ma were identified among 39 malignant effusions. Two patients with met astatic squamous-cell carcinoma presented with cardiac tamponade, and the other two cases had progressive cardiac failure. The diagnostic ce lls on cytology evaluation were scant in all four cases but exhibited classical features of metastatic squamous carcinoma, such as cytoplasm ic keratinization, intercellular bridges, and occasional ''pearl'' for mation. Pericardial biopsies available in three patients, two With car diac failure and one with cardiac tamponade, were negative. In all fou r cases the primary tumor was a bronchogenic carcinoma. Metastatic squ amous-cell carcinoma is an uncommon cause of pericardial effusion and usually indicates the presence of a bronchogenic carcinoma with a rapi dly fatal outcome. Cytologic examination of pericardial fluid is essen tial in the evaluation of such patients. (C) 1998 Wiley-Liss, Inc.