Case Report

Seorang penderita kanker paru dengan manifestasi efusi perikardium: Laporan kasus

Ida Ayu Nanda Dwijayanthi , Ida Bagus Sutha

Ida Ayu Nanda Dwijayanthi
Program Studi Pendidikan Dokter Spesialis Penyakit Dalam. Email: nandadwijayanthi@yahoo.com

Ida Bagus Sutha
Univeristas Udayana
Online First: August 01, 2020 | Cite this Article
Dwijayanthi, I., Sutha, I. 2020. Seorang penderita kanker paru dengan manifestasi efusi perikardium: Laporan kasus. Intisari Sains Medis 11(2): 590-596. DOI:10.15562/ism.v11i2.591


Background: Based on WHO data, lung malignancy is the most common cause of death in patients with cancer. On the other hand, 10-20% of metastasis involves pericardium.  Pericardial effusion is associated with variety of underlying heart diseases, malignancies, infections and complications of cardiovascular procedures. However, in some cases, MPE may manifest to cardiac tamponade which cause collapse of cardiovascular system and will eventually lead to death.

Case description: We reported 51 years old male patient with chief complain of shortness of breath especially when lying down. Patient has history of the same complaints and had done pericardiocentesis in the past. Patient were now hospitalized with severe pericardium effusion post-cardiocentesis and stage IV pulmonary malignancy. Biopsy showed that the patient had squamous cell carcinoma. Two weeks after the lung biopsy, patient’s condition worsened and patient eventually passed away. Patient was planned to have paclitaxel-carboplatin chemotherapy after biopsy. Pericardium effusion is associated with cardiac metastases, which most often originate from lung malignancy. There are four mechanism of pericardial metastasis, such as direct extension, through blood vessel, lymphatic vessel and through intracavity diffusion either through cava vein or pulmonary vein. Cardiac tamponade is a life-threatening complication caused by accumulation of excessive fluid which cause extracardial compression and haemodynamic instability. Therefore, pericardiocentesis is needed as an emergency and life-saving procedure.

Conclusion: Chemotherapy may increase the survival rate of patients with MPE.

 

Latar belakang: Data WHO menunjukan bahwa kanker paru merupakan penyebab kematian utama akibat keganasan dimana angka insiden keganasan yang melibatkan metastasis pada pericardium sekitar 10-20%. Efusi perikardium sering dihubungkan dengan berbagai macam penyakit seperti penyakit jantung, keganasan, infeksi dan sebagai komplikasi prosedur tindakan kardiovaskuler. Pada beberapa kasus metastasis jantung dapat bermanifestasi menjadi tamponade jantung sehingga menyebabkan kolaps sistem kardiovaskuler yang dengan cepat dapat menyebabkan kematian.

Deskripsi kasus: Kami melaporkan seorang pasien laki-laki berusia 51 tahun dengan keluhan sesak nafas terutama berbaring. Pasien sudah mengalami keluhan yang sama berulangkali dan telah dilakukan perikardiosintesis. Saat ini pasien dirawat dengan efusi perikardium berat post-kardiosentesis dengan keganasan paru stadium IV dengan hasil biopsi karsinoma sel skuamosa. Pasien mengalami perburukan dan meninggal dua minggu setelah biopsi paru. Seharusnya setelah dilakukan biopsi paru, pasien direncanakan untuk menjalani kemoterapi paclitaxel-carboplatin. Efusi pericardium sering dikaitkan dengan proses metastase jantung dimana penyebabnya paling banyak berasal dari keganasan pada paru. Penyebaran tumor ke jantung dapat melalui empat jalur yaitu secara langsung (direct extension), melalui pembuluh darah, melalui sistem limfe dan melalui difusi intrakavitas baik melalui vena kava maupun vena pulmonaris. Komplikasi yang sering terjadi adalah tamponade jantung yaitu suatu kondisi mengancam jiwa yang disebabkan oleh akumulasi cairan yang terlampau banyak sehingga menyebabkan kompresi ekstrakardial dan gangguan hemodinamik yang membahayakan sehingga diperlukan perikardiosentesis sebagai tindakan emergensi.

Kesimpulan: Pemberian kemoterapi dapat memberikan peningkatan angka kesintasan pasien.

References

WHO. Global battle against cancer won’t be won with treatment alone :Effective prevention measures urgently needed to prevent cancer crisis. International Agency for Research on Cancer. London, 2014

Perhimpunan Dokter Paru Indonesia. Kanker paru: Pedoman diagnose & penatalaksanaan di Indonesia. 2003

Cruza, AP, Garzab CV, Avilab BT, Torresa J, et al. Effectiveness and prognosis of initial pericardiocentesis in the primary management of malignant pericardial effusion. Interact CardioVasc Thorac Surg (2010) 11 (2): 154-161. doi: 10.1510/icvts.2010.232546

Gornik HI, Herman MG, Beckman JA. Abnormal cytology predicts poor prognosis in cancer patients with pericardial effusion. American Society of Clinical Oncology. J Clin Oncol (2005) 23:5211-5216

Roswati E,dan Safri Z. Perikardiosentesis pada efusi perikardium masif. CDK-202/ 2013: 40(3):192-196,

Gumrukcuoglu HA, Odabasi D, Akdag S, Ekim H. Management of cardial tamponade: a comparative study between echo-guided pericardiocentesis and surgery – A report of 100 patients. Cardiol Res Pract. 2011; 2011: 197838

Fidler, Isaiah J. The Pathogenesis of cancer metastasis: the ‘seed and soil’ hypothesis revisited. Nature Review Cancer 3, 453-458. 2003, doi: 10.1038/nrc 1098

Soler JS, Sauleda JS, Miralda GP., Jordi Soler-Soler. General pericardiology: Management of pericardial effusions. Heart 2001; 86: 230-245.

Semenza GL. Hypoxia-inducible factors: mediators of cancer progression and targets for cancer therapy. Trends Pharmacol Sci. 2012;33(4):207-214.

Bussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastase. J Clin Pathol. 2007; 60 (1): 27-34.

Wang PC, Yang KY, Chao JY, et al. Prognostic role of pericardial fluid cytology in cardiac tamponade associated with non-small cell lung cancer. Chest. 2000;118(3):744-9.

Wilkes JD, Fidias P, Vaickus L, Peres RP. Malignancy-related pericardial effusion; 127 cases from the Roswell Park Cancer Institue. Cancer 1995, 2015;76(8):1377-87.

Sagristà-Sauleda J, Mercé J, Permanyer-Miralda G, Soler-Soler J. Clinical clues to the causes of large pericardial effusions. Am J Med. 2000;109(2):95-101.

Maisch B, Ristic AD. Practical aspect of the management of pericardial disease. Heart 2003; 89: 1096-1103

Maisch B, Chairperson*, Seferovic PM, et al. Guidelines on the diagnosis and management of pericardial disease -Full Text : The task force on the diagnosis and management of pericardial disease of the European society of cardiology. Eur Heart J, 2004

Cruz GA, Garza CV, Avilab BT, et al. Effectiveness and prognosis of initial pericardiocentesis in the primary management of malignant pericardial effusion. Interact CardioVasc Thorac Surg (2010) 11 (2): 154-161

Cormican MC dan Nyman CR. Intrapericardial bleomycin for the management of cardiac tamponade secondary to malignant pericardial effusion. Br Heart J 1990; 63: 61-2

Maisch B, Ristic AD, Pankuweit S, et al. Neoplastic pericardial effusion; Efficacy and safety of intrapericardial treatment with cisplatin. Eur Heart J, 2002; 23: 1625-1631.

Azzoli CG, Baker S, Temin S, et al. American society of clinical oncology clinical practice: guideline update on chemotherapy for stage IV non–small cell lung cancer. American Society of Clinical Oncology. JCO, 2009; 27(36): 6251-6266.

Laham RJ, Cohen DJ, Kuntz RE, et al. Pericardial effusion in patients with cancer: outcome with contemporary management strategies. Heart, 1996; 75: 67-71


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