Pericardial carcinomatosis in a patient with gastric cancer

Gastric cancer remains a pressing issue in oncology. One of the rare but extremely dangerous complications is metastasis to the pericardium, leading to carcinomatous pericarditis. This article presents a clinical case of a 68-year-old patient with diffuse gastric adenocarcinoma who received neoadjuvant chemotherapy followed by gastrectomy. On the third day after surgery, the patient died from pericardial hemotamponade caused by coronary artery erosion secondary to pericardial carcinomatosis, which was diagnosed during pathological examination. A review of the literature shows that pericardial metastases from gastric cancer are extremely rare (4.2 % of patients), more often associated with poorly differentiated and signet-ring cell carcinoma, and are often diagnosed at terminal stages or even postmortem. The clinical presentation is nonspecific, complicating early detection. Diagnosis is based on echocardiography; however, as demonstrated in this case, changes may not be apparent until death. Treatment remains challenging due to the low incidence of this condition. Pericardiocentesis in combination with systemic or local chemotherapy can prolong survival, but the prognosis is generally poor. This suggests the need for increased vigilance in patients with gastric cancer and cardiovascular symptoms, as well as the importance of developing diagnostic algorithms for the early detection of pericardial lesions, especially in patients with comorbid cardiac pathology.