Malignant pericardial tamponade in a patient with hormone-refractory prostate cancer

An 82-year-old man who was receiving treatment for prostate cancer and cholangiocellular carcinoma was admitted to our hospital because of chest discomfort and dyspnea. At the time of admission, 16 months after the start of hormone therapy, the prostate-specific antigen level was 454.08 ng/ml. Chest radiography revealed cardiomegaly, and ultrasonography demonstrated significant pericardial effusion. Pericardiocentesis yielded a hemorrhagic exudate, and a routine cytological study revealed malignant cells. It was difficult to determine whether these cells had originated from the prostate cancer or the cholangiocellular carcinoma. However, immunohistochemical analysis of a cell-block section of the pericardial effusion allowed a diagnosis of pericardial metastasis from the prostate cancer. After drainage and intrapericardial injection of cisplatin, the amount of effusion was decreased. After removal of the pericardial drain, the patient was discharged, but the pericardial effusion was found to have accumulated again 1 month later.