Complicating pericarditis and cardiac tamponade in a patient of primary HER2/neu positive gastric signet ring cell carcinoma

Cardiac complications caused by metastatic gastric cancer are rarely reported. Here, we report a 58-year old woman who presented with chronic cough and intermittent shortness of breath for weeks. Chest radiographs showed a cardiac silhouette sign and a small amount of pleural effusion. After serial examinations including biopsy of the pericardium, ovarian and stomach, metastatic strong HER2/neu expressive signet-ring cell carcinoma of the stomach was diagnosed. Despite aggressive management with best supportive care and intravenous administration of trastuzumab, the patient died of respiratory failure and refractory pleural effusion. Through this case, we demonstrate that HER2/neu positive metastatic gastric cancer can initially present with these unusual cardiac and systemic manifestations. Primary clinical physicians should be aware of this unusual manifestation of gastric cancer.