Unusual Cardiac Infiltration in Diffuse Large B-Cell Lymphoma

European Heart Journal - Case Reports

Background Primary cardiac tumors are extremely rare with an autopsy incidence of 0.05%. They can present with a variety of symptoms, including life threatening arrhythmia and cardiac tamponade. In this case report, we focus on the diagnostic process and management of a primary cardiac lymphoma presenting with cardiac tamponade. Case summary We report on a 71-year-old male presenting with a large pericardial effusion, tamponade, and a mass in the right atrioventricular groove. Multimodality imaging was performed, including transthoracic echocardiography, computed tomography, magnetic resonance imaging, positron emission tomography and computed tomography-guided transthoracic biopsy The final diagnosis of a double-hit diffuse large cell B-cell lymphoma was made, for which treatment consisting of a combination of chemotherapy and immunotherapy was initiated. Low-dose colchicine was also added to the treatment. Discussion Primary cardiac lymphoma remains a very rare diagnosis and this ...

PubMed, 2008

Cardiac involvement as an initial presentation of malignant lymphoma is a rare occurrence. We describe the case of a 77-year-old man who had initially been diagnosed with a left atrial mass on an echocardiogram, presenting with progressive dyspnea, dysphagia, odynophagia and fevers. The cardiac mass had been managed as an outpatient with full anticoagulation for the suspicion of clot. On admission, cardiac magnetic resonance imaging revealed a large mediastinal mass invading the left atrium that originated from the oesophagus. A barium oesophagram revealed an apple core lesion involving the distal third of the oesophagus. A subsequent computed tomography scan demonstrated a large mediastinal soft tissue mass and paratracheal lymphadenopathy. A flexible upper endoscopy revealed an oesophageal mass that was approximately 10 cm in length, irregular at the margins, and with a very necrotic appearance. This was biopsied, revealing findings consistent with high grade diffuse large B cell lymphoma. This case illustrates lymphoma presenting with dyspnea, odynophagia and a left atrial mass. To our knowledge, there are no reported cases of diffuse large B cell lymphoma presenting as odynophagia and a cardiac mass.

CASE, 2019

Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, 2012

A 73-year-old woman presented in right heart failure. Computed tomography of the chest revealed a 3 cm × 5 cm anterior mediastinal mass. Contrast-enhanced two-dimensional transthoracic echocardiography, cardiac magnetic resonance imaging (MRI), positron emission tomography (PET), and MRI-PET fusion demonstrated invasion of the pericardium and right heart by the tumor. Mediastinal biopsy revealed high-grade diffuse large B-cell lymphoma, which responded to chemotherapy. The role of each modality in this case was discussed in the manuscript. In conclusion, the integration of multiple imaging modalities is extremely useful in the characterization, localization, diagnosis and treatment of an unusual cardiac mass.

American Journal of Hematology, 2009

A separate report concerning the same patient has recently been published (Cardiology Journal 2008;15:471-474). That article focuses only on the cardiology perspective for diagnosis, and does not involve any discussion regarding management from the oncological standpoint, nor does it reveal the autopsy photograph.

Revista médica de Chile, 2021

Primary myocardial involvement of Diffuse Large B-Cell lymphoma is extremely rare, accounting for 0.5 % of all lymphomas. We report a 65-year-old male, presenting with an acute cardiac tamponade, which was drained. A pericardial window with myocardial biopsy was carried out, disclosing a diffuse large B cell lymphoma. He received 6 cycles of rituximab, cyclophosphamide, vincristine, and prednisone (R-CVP), without response. Finally, a palliative chemotherapy with gemcitabine plus oxaliplatin was prescribed.

Cureus

The cardiac localization of metastases is a rare condition, most often found on autopsy. Lymphoma is among the primary cancers often involved, as was the case for our patient in whom cardiac involvements were discovered during the extension assessment by imaging. Clinically asymptomatic in the majority of cases, we mainly find general symptoms related to the primary disease. Because histological diagnosis is rarely possible by biopsy, confirmation is made by imaging in the context of disseminated disease. The treatment of cardiac involvements of lymphomatous origin is often medical with a poor prognosis.

The thoracic and cardiovascular surgeon reports, 2023

Radiographics, 2012

Lymphoma of the heart and pericardium is usually present as one aspect of disseminated disease and rarely occurs as a primary malignancy. It accounts for 1.3% of primary cardiac tumors and 0.5% of extranodal lymphomas. Cardiac lymphomas are most commonly diffuse large cell lymphomas and frequently manifest as an ill-defined, infiltrative mass. Atrial location is typical; the right atrium is most often affected. Pericardial thickening or effusion is often a common early feature of disease. Infiltration of atrial or ventricular walls with extension along epicardial surfaces is also a notable feature. At computed tomography, the attenuation of cardiac lymphoma may be similar to or lower than that of normal myocardium. At magnetic resonance imaging, it has variable signal intensity and contrast enhancement. Clinical manifestations may include pericardial effusion, cardiac arrhythmias, and a variety of nonspecific electrocardiographic abnormalities, notably first-to third-degree atrioventricular block. Treatment most commonly includes anthracycline-based chemotherapy and anti-CD20 treatment. Chemotherapy has been used alone or combined with radiation therapy. Palliative surgery has been performed, mainly for tumor debulking. The prognosis for patients with either primary or secondary lymphomatous heart involvement is usually poor; late diagnosis is one of the major factors affecting outcome. ©

The Annals of Thoracic Surgery