Normal Tumor Markers and Increased Adenosine Deaminase in Pericardial Effusion Misdiagnosed as Tuberculous Pericarditis Ultimately Proven as Lung Adenocarcinoma with Pericardial Metastasis: a Case Report and Literature Review

Clin Lab. 2019 May 1;65(5). doi: 10.7754/Clin.Lab.2018.181036.

Abstract

Background: Elevated adenosine deaminase (ADA) and normal tumor markers in pericardial or pleural effusion are usually considered to be a specific manifestation of benign pericardial or pleural effusion. Here we report a case of lung adenocarcinoma with pericardial metastasis with elevated ADA and normal tumor markers in pericardial effusion.

Methods: Pericardiocentesis and lung puncture combined laboratory indexes and pathology were performed for diagnosis.

Results: Analysis of pericardial fluid revealed a white blood cell (WBC) count of 2,000 x 106/L (70% for lymphocytes) with an ADA level of 72.8 U/mL. Pathology of pericardial effusion found no malignant cells. Histopathology of percutaneous lung puncture showed adenocarcinoma.

Conclusions: ADA and tumor markers were not a specific index in differential diagnosis between tuberculosis and metastasis in pericardial effusion.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adenocarcinoma / diagnosis*
  • Adenosine Deaminase / metabolism*
  • Biomarkers, Tumor / analysis
  • Diagnostic Errors
  • Female
  • Humans
  • Lung Neoplasms / diagnosis*
  • Middle Aged
  • Pericardial Effusion / diagnosis*
  • Pericardial Effusion / metabolism
  • Pericarditis, Tuberculous / diagnosis*
  • Pericardium / pathology*
  • Pleural Effusion / diagnosis
  • Pleural Effusion / metabolism

Substances

  • Biomarkers, Tumor
  • Adenosine Deaminase