Gynecological Neoplasms are the Major Cause for Malignant Effusions

Abstract

\n Background:\u2003Malignant effusions occur frequently in gynecologic neoplasms and may worsen the prognosis for these patients. Therefore a more detailed analysis for the different cavities is necessary to describe the association between the various histological subtypes and the time related occurrence of malignant effusions in gynecological malignancies. Methods:\u2003Malignant effusion specimens from patients diagnosed at Bayreuth Hospital from June 2013 to December 2018 were reevaluated retrospectively and correlated with the histolgogical subtype of primary tumors and with the clinical follow-up.Results:\u2003435 patients with malignant effusions were analyzed, including 273 women and 162 men. 54.2% of patients developed malignant effusions in the pleural space in (54.2%) patients, in the peritoneum in (43.9%) patients and in the pericardium in (1.9%). Gynecological malignancies appear most common in (n=147, 34.0%; mean age 67.3 years) patients with predominant occurrence of ovarian carcinoma in malignant abdominal cytology in 75/191 (39.3%) patients, mostly of high-grade serous papillary subtype in 72/75 (96.1%), and only breast cancer in malignant pleural effusions in 49/236 (20.7%), frequently of 39/49 (79.6%) invasive carcinomas of no specific type. Both involvement of pleural- and peritoneal cavity in 244 female patients with gynecological-, lung- and gastrointestinal neoplasms we obtained in 37 (15.2%) patients, most common in 31/37 (83.78%) gynecological tumors and exclusively of high-grade serous papillary subtype. Malignant ascites occured in patients with lower genital tract tumors in 81/86 (94.2%) within one year after primary diagnosis, whereas breast cancer involves the peritoneum in 2/10 (20%) and the pleural cavity in 11/49 (22.4%) after 12 months. Conclusions:\u2003Gynecological neoplasms were the major cause of malignant effusions in our study. The high-grade serous papillary subtype of lower tract gynecological is most aggressive with predominant occurrence in the peritoneum and exclusive secondary involvement of the pleural cavity. Therefore, an alone/exclusive/sole involvement of the pleural cavity characterize the invasive breast carcinoma of no special type compared to predominant occurrence of the lobular subtype in malignant ascites. Breast cancer showed a statistical significant late occurrence in effusion fluids 12 months after primary diagnosis in contrast to early involvement in gynecological- as well as pulmonary- or gastrointestinal malignancies.