Primary cardiac diffuse large B cell lymphoma – a case report

Abstract

We present a rare case of primary cardiac diffuse large B cell lymphoma with unusual presentation. Our female patient, 34 years old, presented with superior vena cava syndrome that was related to thrombophlebitis post breast augmentation. She was treated with anticoagulants but was admitted again, ten months later, due to an aggravation in her state. MRI imaging demonstrated a large mass in her right atrium that was surgically removed. The resected mass was 6 cm in diameter, lobulated and white. Microscopically, the tumor consisted of sheets of large atypical cells, with wide nuclei and prominent nucleoli. Numerous mitotic figures and necrosis were present. On immunostains the tumor cells showed strong diffuse positive staining for CD20, CD30 and vimentin. All other markers for epithelial and muscle tumors, as well as melanoma were negative. Ki67 was positive in 75% of the cells. ALK status was evaluated by both immunohistochemistry and FISH study. The diagnosis was concluded as primary cardiac diffuse large B cell lymphoma. Primary cardiac lymphoma is a very rare entity and its diagnosis is unanticipated by both clinicians and pathologists. We present the case, discuss the differential diagnosis and review the literature.