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1.
Medicine (Baltimore) ; 98(42): e17584, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626128

RESUMO

RATIONALE: High-stage endometrial carcinoma is an aggressive tumor with a high propensity for distant spread. However, metastases to the pericardium are rare in gynecological cancer, and are usually fatal. PATIENT CONCERNS: A 69-year-old woman was diagnosed with endometrial carcinoma with pericardium metastasis. The symptoms at presentation were panic and shortness of breath. DIAGNOSES: The cytologic examination of pericardial fluid obtained by pericardiocentesis confirmed metastasis. INTERVENTIONS: In addition to cisplatin instilled into the pericardial space, for systemic chemotherapy, we chose that gemcitabine and lobaplatin regimen be preferred. OUTCOMES: The patient has been participating in telephone follow-up for 8 months and has generally remained in a good condition. LESSONS: Endometrial carcinoma can have pericardial metastases. When this happens, we recommend ultrasound-guided pericardial puncture and the pericardial injection of cisplatin, in combination with systemic chemotherapy that consists of gemcitabine and lobaplatin.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias do Endométrio/secundário , Neoplasias Cardíacas/complicações , Derrame Pericárdico/etiologia , Pericardiocentese/métodos , Idoso , Terapia Combinada , Diagnóstico Diferencial , Ecocardiografia , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/terapia , Feminino , Neoplasias Cardíacas/secundário , Neoplasias Cardíacas/terapia , Humanos , Imagem por Ressonância Magnética , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/terapia , Pericárdio , Tomografia Computadorizada por Raios X
2.
BMJ Case Rep ; 12(9)2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511262

RESUMO

A 12-year-old boy presented with central chest pain, shortness of breath and type 1 respiratory failure. He had a background of graft versus host disease (GvHD), which was currently managed with imatinib therapy. A focused bedside ultrasound scan was performed revealing a large pericardial effusion. The child was referred to a tertiary paediatric cardiology centre where he underwent emergency pericardiocentesis, draining a total of 800 mL of pericardial fluid. Fluid analysis excluded infection, and with no other concerns for a GvHD flare the diagnosis of an imatinib-induced pericardial effusion was made. On terminating the therapy, the pericardial collection did not reaccumulate. Tyrosine kinase inhibitor-induced pericardial and/or pleural effusion should be considered as a differential diagnosis in paediatric patients on this therapy presenting in a similar manner.


Assuntos
Mesilato de Imatinib/efeitos adversos , Derrame Pericárdico/induzido quimicamente , Inibidores de Proteínas Quinases/efeitos adversos , Criança , Doença Enxerto-Hospedeiro/tratamento farmacológico , Humanos , Masculino , Derrame Pericárdico/diagnóstico
3.
Cardiol Young ; 29(10): 1278-1281, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31475645

RESUMO

We report a case of a 13-year-old male with trisomy 21 in Southwestern Ontario, Canada, who presented with bilateral pneumonia, pericardial effusion, and peripheral oedema. The pericardial effusion did not respond to standard treatment options. Evaluation revealed severe dietary restriction, consistent with kwashiorkor. Hospital course was complicated by severe hypoalbuminaemia, hypocalcaemia, hypomagnesaemia, and hypophosphataemia. The pericardial effusion and other findings resolved gradually upon slow introduction of a well-balanced diet and adequate caloric and protein intake. Kwashiorkor is an unusual cause of pericardial effusion and can be overlooked especially in developed countries. It is a type of protein-calorie malnutrition often seen in children of impoverished countries and famine. It is a result of insufficient protein intake in the context of adequate caloric intake. Pericardial effusion not responding to usual treatment is a challenge, and other aetiologies must be considered. Malnutrition is often underdiagnosed or misdiagnosed in developed countries with devastating outcomes if unrecognised. This makes it imperative to consider this diagnosis, recognise potential risk factors, and be prepared to accurately assess overall nutritional status.


Assuntos
Ecocardiografia/métodos , Kwashiorkor/complicações , Derrame Pericárdico/diagnóstico , Pericárdio/diagnóstico por imagem , Adolescente , Diagnóstico Diferencial , Humanos , Kwashiorkor/diagnóstico , Masculino , Derrame Pericárdico/etiologia
5.
ABC., imagem cardiovasc ; 32(3): 214-216, jul.-set. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1006712

RESUMO

Relatamos o caso de um paciente jovem admitido no pronto-socorro com quadro de dor precordial. O eletrocardiograma de admissão identificou supradesnivelamento do segmento ST localizado em parede lateral associado à imagem em "espelho", com enzimas cardíacas altamente elevadas, o que sugere diagnóstico de síndrome coronariana com supradesnivelamento de ST. O ecocardiograma evidenciou derrame pericárdico com fração de ejeção preservada e ausência de alterações segmentares, sugerindo, assim, pericardite aguda, com comprometimento do miocárdio. Desta forma, foi realizada ressonância magnética cardíaca, que evidenciou presença de realce tardio não isquêmico, confirmando o diagnóstico de perimiocardite. Trata-se de situação pouco frequente na prática clínica e que merece maior compreensão e atenção por parte dos médicos que trabalham em prontos-socorros


Assuntos
Humanos , Masculino , Adolescente , Eletrocardiografia/métodos , Miocardite , Derrame Pericárdico/complicações , Derrame Pericárdico/diagnóstico , Infecção/complicações , Infarto do Miocárdio
6.
Clin Lab ; 65(5)2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31115232

RESUMO

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.


Assuntos
Adenocarcinoma/diagnóstico , Adenosina Desaminase/metabolismo , Neoplasias Pulmonares/diagnóstico , Derrame Pericárdico/diagnóstico , Pericardite Tuberculosa/diagnóstico , Pericárdio/patologia , Biomarcadores Tumorais/análise , Erros de Diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Derrame Pericárdico/metabolismo , Derrame Pleural/diagnóstico , Derrame Pleural/metabolismo
7.
Ir Med J ; 3(112): 902, 2019 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-31124350

RESUMO

Aim To report the first case of cardiac tamponade related to Infliximab induction therapy in an Ulcerative Colitis patient. Methods Review of published case reports. Results This complication was likely due to a type 3 hypersensitivity immune-complex reaction resulting in a reactive pericardial effusion Discussion Though rare, this case demonstrates how autoimmune reaction to anti-TNF𝛼 therapy can initially mimic infection, as our patient presented with tachycardia, hypotension, raised inflammatory and infective markers and fever.


Assuntos
Tamponamento Cardíaco/induzido quimicamente , Colite Ulcerativa/tratamento farmacológico , Fármacos Gastrointestinais/efeitos adversos , Infliximab/efeitos adversos , Autoimunidade , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/imunologia , Tamponamento Cardíaco/terapia , Colite Ulcerativa/imunologia , Feminino , Fármacos Gastrointestinais/administração & dosagem , Fármacos Gastrointestinais/imunologia , Humanos , Infliximab/administração & dosagem , Infliximab/imunologia , Pessoa de Meia-Idade , Derrame Pericárdico/induzido quimicamente , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/imunologia , Derrame Pericárdico/terapia , Resultado do Tratamento , Fator de Necrose Tumoral alfa/imunologia
8.
PLoS One ; 14(5): e0217007, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31095610

RESUMO

BACKGROUND: The prognosis of lung cancer with malignant pericardial effusion is very terrible owing to the impact of cardiac tamponade. The aim of our study seeks to identify prognostic factors and establish a prognostic nomogram of non small cell lung cancer (NSCLC) with malignant pericardial effusion. METHODS: NSCLC patients with malignant pericardial effusion between 2010 and 2014 are searched from SEER database.Cancer-specific death of these patients are analyzed through the Kaplan-Meier method, Cox proportional hazard model and competing risk model. Prognostic nomogram of cancer-specific death is performed and validated with concordance index (C-index), calibration plots and internal validation population. Propensity score matching is used to evaluate whether chemotherapy affected the survival of study population. RESULTS: 696 eligible NSCLC patients are involved in the study population, with 22.7% of 1-year survival rate and 8.9% of 2-year survival rate. Laterality, AJCC N, AJCC T, and chemotherapy are regarded as independent prognostic factors of cancer-specific death in the Cox proportional hazards model and competing risk model. The C-index of established nomogram is 0.703(95%CI:0.68-0.73) for cancer-specific death in the study population with acceptable calibration, which is significantly higher than classical TNM stage(C-index = 0.56, 95%CI:0.52-0.60). After 1:1 propensity score matching, chemotherapy potentially reduces the risk of cancer-specific death (HR = 0.42 95%CI: 0.31-0.58) of NSCLC with pericardial effusion. CONCLUSIONS: NSCLC with malignant pericardial effusion harbors low overall survival. One prognostic nomogram based on laterality, AJCC N, AJCC T and chemotherapy is developed for cancer-specific death to predict 1-year and 2-year survival rate with good performance.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Nomogramas , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/mortalidade , Idoso , Calibragem , Carcinoma Pulmonar de Células não Pequenas/fisiopatologia , Tamponamento Cardíaco/complicações , Tamponamento Cardíaco/diagnóstico , Causas de Morte , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/fisiopatologia , Prognóstico , Pontuação de Propensão , Modelos de Riscos Proporcionais , Programa de SEER , Taxa de Sobrevida , Resultado do Tratamento , Estados Unidos
9.
Int J Infect Dis ; 83: 102-108, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30930185

RESUMO

OBJECTIVES: The pericardial effusion (PE) caused by paragonimiasis is rarely reported. This study aims to present experience in the diagnosis and surgical management of PE due to paragonimiasis. METHODS: Medical records of 57 children who were diagnosed with PE due to paragonimiasis and underwent surgery at Children's Hospital of Chongqing Medical University between January 2012 and August 2018 were retrospectively reviewed. RESULTS: The average age of this group was 7.6 ± 3.0 years. Patients were mainly from Chongqing and Sichuan areas. ELISA for Paragonimus skrjabini in all 57 patients showed positive results. Moderate or large PE were identified in 12 and 45 patients, respectively. All patients underwent surgery either by pericardectomy or thoracoscopic surgery. Pathological exams indicated massive eosinophil infiltration in all 57 specimens. After 3-4 courses of praziquantel therapy, the clinical outcomes were satisfactory. CONCLUSIONS: Typical endemic history, eosinophilia and multiple serous effusion raise suspicions of paragonimiasis. Once moderate to large PE is identified in patients with paragonimiasis, surgical treatment is necessary.


Assuntos
Paragonimíase/complicações , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/cirurgia , Adolescente , Animais , Anti-Helmínticos/uso terapêutico , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Eosinofilia/parasitologia , Feminino , Humanos , Masculino , Paragonimus , Derrame Pericárdico/parasitologia , Praziquantel/uso terapêutico , Estudos Retrospectivos
11.
Indian Heart J ; 71(1): 80-84, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31000188

RESUMO

BACKGROUND: Pericardial effusion (PE) is widely believed to signify more advanced infective endocarditis (IE) and a generally worse outcome. PURPOSE: To determine the prevalence and clinical significance of PE in a series of patients with confirmed native and prosthetic valve infections. METHODS: Data were collected from 338 consecutive patients with definite or possible IE who visited a single referral center; these patients were examined for the presence of PE as detected by transthoracic echocardiography. Clinical characteristics, the incidence of complications, and outcomes were compared between patients with IE with and without PE. IE patients with PE were then divided into two subgroups: those with and those without cardiac prostheses. RESULTS: Eighty-eight patients out of the total 338 (26%) were found to have PE. Compared with patients who did not have PE, patients who did were significantly younger (32.9 ± 13.4 vs 29.0 ± 9.2, p = 0.003), had more left-sided vegetation (55.6% vs 77.3%, p < 0.001), more root abscesses (9.2% vs 25.0%, p < 0.001), needed surgery more frequently (68.0% vs 84.1%, p = 0.001), and had a higher mortality rate (22.0% vs 32.9%, p = 0.03). PE was not found to be a predictor of mortality. No significant difference was found between IE patients with PE with (n = 13) and without (n = 75) prostheses with regard to causative organisms, clinical characteristics, or clinical outcomes. CONCLUSION: Regardless of whether the IE was in native or prosthetic valves, compared with patients without PE, patients with PE had more severe infections and a worse prognosis, but PE was not an independent predictor of mortality.


Assuntos
Endocardite/complicações , Próteses Valvulares Cardíacas/efeitos adversos , Derrame Pericárdico/etiologia , Infecções Relacionadas à Prótese/complicações , Adulto , Ecocardiografia Transesofagiana , Egito/epidemiologia , Endocardite/diagnóstico , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/mortalidade , Prognóstico , Estudos Prospectivos , Infecções Relacionadas à Prótese/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências
12.
Hemoglobin ; 43(1): 1-3, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30879337

RESUMO

Purulent pericarditis is a localized infection with a thick, fibrinous hypercellular exudate and is historically associated with a high mortality. We describe a case of purulent pericarditis due to Streptococcus agalactiae (S. agalactiae) in a 30-year-old woman with sickle cell disease who presented with fever, dyspnea, and S. agalactiae septicemia. Despite timely initiation of antibiotics, she developed a large purulent pericardial effusion requiring surgical pericardiocentesis followed by a pericardial window. At 14 months follow-up, she has remained asymptomatic without sequelae. A review of the literature contained only four patients with purulent pericarditis in sickle cell patients. We discuss the unique aspects of this case in the context of purulent pericarditis in the age of modern antibiotics and hypothesize on the pathogenesis of delayed pericardial effusion after pericarditis.


Assuntos
Anemia Falciforme/complicações , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae , Adulto , Animais , Biomarcadores , Terapia Combinada , Ecocardiografia , Feminino , Humanos , Derrame Pericárdico/terapia , Pericardiocentese , Radiografia Torácica , Avaliação de Sintomas , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
J Int Med Res ; 47(5): 2262-2268, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30898056

RESUMO

Tuberculosis is still the leading cause of pericardial disease in developing nations. A definite diagnosis of tuberculosis is usually relatively difficult, especially when its manifestations are not typical. We report a 19-year-old man who presented with chest obstruction, shortness of breath, edema of the lower extremities, and mild fever for 14 days. The manifestations of tuberculosis pneumonia were not typical, except for a small high-density shadow in the left upper lung field near the pleura, with a small amount of pleural effusion on chest computed tomography. The tuberculin skin test, acid-fast stain of sputum and pericardial effusion, and bacterial culture showed negative results. Echocardiography showed three free-floating irregular masses in a large amount of pericardial effusion. The masses and exudates were removed by pericardiectomy. The masses were composed of hyperplastic granulation tissue and dead tissue without a normal architecture, mixed with numerous caseous substances, which confirmed the diagnosis of tuberculous pericarditis. This is a unique report of a patient who presented with tuberculous pericarditis with multiple solid masses in a large amount of pericardial effusion, without typical clinical manifestations of tuberculosis.


Assuntos
Neoplasias Primárias Múltiplas/diagnóstico , Derrame Pericárdico/diagnóstico , Pericardite Tuberculosa/diagnóstico , Diagnóstico Diferencial , Ecocardiografia , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/patologia , Pericardiectomia , Pericardite Tuberculosa/diagnóstico por imagem , Pericardite Tuberculosa/patologia , Tomografia Computadorizada por Raios X , Adulto Jovem
14.
Rev Port Cardiol ; 38(2): 97-101, 2019 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30876791

RESUMO

INTRODUCTION: Pericarditis is an inflammation of the pericardium. It may be infectious or secondary to a systemic disease. The aim of this study was to analyze the clinical findings, course, treatment and follow-up of children diagnosed with pericarditis at our center. METHODS: We performed a retrospective analysis of all children admitted to our pediatric cardiology unit with pericarditis between 2003 and 2015. Patient characteristics were summarized using frequencies and percentages for categorical variables and medians with percentiles for continuous variables. RESULTS: Fifty patients were analyzed (40 male, 10 female) with a median age of 14 years. The most common diagnosis was acute pericarditis (80%). Thirty-five patients (70%) presented with chest pain and 26% reported fever. Cardiomegaly was identified on chest X-ray in 11 patients (22%), 30 patients (60%) had an abnormal ECG and 44 patients (80%) had alterations on the transthoracic echocardiogram. In 17 cases (34%) there was myocardial involvement. Forty-eight percent of patients presented with infectious pericarditis and the pathologic agent was identified in half of them. Postpericardiotomy syndrome was diagnosed in five cases. The first-line therapy was aspirin in 50% of cases. Pericardiocentesis was performed in 12 patients. The median length of stay was nine days. There was symptom recurrence in seven children. CONCLUSIONS: In this study, acute infectious pericarditis was the most common presentation and about one third of patients also had myocarditis. The symptom recurrence rate was not negligible and is probably related to the type of therapy employed.


Assuntos
Ecocardiografia/métodos , Pericardite/diagnóstico , Pericárdio/diagnóstico por imagem , Doença Aguda , Adolescente , Criança , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiologia , Derrame Pericárdico/cirurgia , Pericardiocentese , Pericardite/complicações , Recidiva , Estudos Retrospectivos
16.
Am J Cardiol ; 123(8): 1351-1357, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30765065

RESUMO

Case reports have reported immune checkpoint inhibitors (ICI), especially nivolumab, are associated with recurrent pericardial effusions. Our objective was to determine how often patients being treated with ICI develop hemodynamically significant pericardial effusion requiring pericardiocentesis compared with other cancer therapeutics and whether the survival of patients who underwent pericardiocentesis differs according to ICI use versus standard cancer therapeutics. Our institutional review board approved catheterization laboratory data collection for all pericardiocenteses performed and all patients receiving ICI from January 1, 2015 to December 31, 2017. Retrospective review of the electronic medical record was performed to identify cancer therapeutics given preceding pericardiocentesis. Log-rank analysis was performed to compare survival in patients requiring pericardiocentesis between those on ICI and those not on ICI. Overall, 3,966 patients received ICI of which only 15 pericardiocenteses were required, including 1 repeat pericardiocentesis in a patient on nivolumab. The prevalence of pericardiocentesis among patients on ICI was 0.38% (15/3,966). Eleven pericardiocenteses were performed after nivolumab infusion, 3 after pembrolizumab, and 1 after atezolizumab, with pericardiocentesis prevalences for each agent of 0.61% (11/1,798), 0.19% (3/1,560), and 0.32% (1/309), respectively. One hundred and twenty pericardiocentesis were performed on patients receiving other cancer therapeutics although no therapeutic agent was associated with more pericardiocenteses than nivolumab. In conclusion, the prevalence of hemodynamically significant pericardial effusions and ICI administration is uncommon, and survival durations after pericardiocentesis for patients receiving ICI and those not receiving ICI are similar, suggesting that frequent echocardiographic monitoring for pericardial effusions is not necessary.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Neoplasias/tratamento farmacológico , Derrame Pericárdico/etiologia , Pericardiocentese/métodos , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/mortalidade , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/cirurgia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Texas/epidemiologia
17.
J Coll Physicians Surg Pak ; 29(1): 33-36, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30630566

RESUMO

OBJECTIVE: To differentiate between adenocarcinoma cells and reactive mesothelial cells (RMC) in serous effusions using a limited immuno-panel of Ber-EP4 and Calretinin. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Pathology, Allama Iqbal Medical College, Lahore, in collaboration with the Departments of Surgery, Pulmonology and Oncology, Jinnah Hospital, Lahore, from March 2015 to March 2016. METHODOLOGY: Ninety-seven clinically and radiologically proven cases of peritoneal and pleural effusion and peritoneal wash of patients with suspicion of malignancy were included in the present study. Diagnostic accuracy of a limited immuno-panel of Calretinin and Ber-EP4 for diagnosis of malignant effusions was calculated using histopathology as gold standard. RESULTS: The sensitivity of Ber-EP4 for malignant cases was 98.6%, specificity 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 96%, and diagnostic accuracy 98.9%. Sensitivity of Calretinin as positive staining for RMC was 79.2%, specificity and positive predictive value (PPV) 100%, negative predictive value (NPV) 93.6%, and diagnostic accuracy 94.8%. CONCLUSION: Limited immuno-panel of Calretinin and Ber-EP4 had a high positive and negative predictive value and is cost-effective in resource limited set-up for identification of adenocarcinoma cells and reactive mesothelial cells in challenging cases of serous effusions.


Assuntos
Biomarcadores Tumorais/imunologia , Calbindina 2/imunologia , Mesotelioma/diagnóstico , Mesotelioma/patologia , Derrame Pericárdico/patologia , Derrame Pleural Maligno/patologia , Derrame Pleural/diagnóstico , Adenocarcinoma/diagnóstico , Adenocarcinoma/imunologia , Adenocarcinoma/metabolismo , Adenocarcinoma/patologia , Biomarcadores Tumorais/metabolismo , Biópsia , Calbindina 2/metabolismo , Células Epiteliais/metabolismo , Epitélio/patologia , Humanos , Imuno-Histoquímica , Mesotelioma/metabolismo , Derrame Pericárdico/diagnóstico , Derrame Pleural/patologia , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/imunologia , Valor Preditivo dos Testes , Sensibilidade e Especificidade
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