Primary Cardiac Lymphoma Presenting Research Articles

PO-05-126 A SHOCKING TURN OF EVENTS: PRIMARY CARDIAC LYMPHOMA AS A RARE CAUSE FOR SUDDEN CARDIAC DEATH

Primary cardiac tumors are rare causes of ventricular arrythmias. This presentation of primary cardiac lymphoma highlights the importance of multimodality cardiac imaging for patients who suffer sudden cardiac arrest. N/A N/A A previously healthy 34 year-old woman suffered an out-of-hospital cardiac arrest. She received bystander CPR and multiple shocks in the field for VT and VF. ECG obtained on arrival showed salvos of monomorphic VT with a LBBB morphology as well as polymorphic VT. Post-arrest ECG demonstrated dynamic changes with evidence of a prolonged QT interval and Brugada type 1 pattern. After stabilization with metoprolol and intravenous lidocaine, cardiac MRI showed an infiltrating mass along the epicardial surface of the right ventricular outflow tract (RVOT). A cardiac CT was subsequently performed for surgical biopsy planning. Biopsy was obtained via hemi-sternotomy; tissue histopathology of the RVOT mass revealed diffuse large B-cell lymphoma. PET and CT scans indicated no evidence of metastatic disease. The patient was diagnosed with primary cardiac lymphoma, and underwent inpatient chemotherapy treatment. A subcutaneous ICD was implanted prior to discharge for secondary prevention. Key images are displayed in Figure 1. This case demonstrates a rare cause of sudden cardiac arrest in a young patient with a new diagnosis of primary cardiac lymphoma. Primary cardiac lymphoma is a very rare disease that accounts for less than 1% of all primary cardiac malignancies, and less than 0.5% of all extra nodal lymphomas. The use of multimodality imaging after a cardiac arrest in this case led to a timely diagnosis and rapid initiation of life saving treatments.

Surgical treatment of a primary cardiac lymphoma presenting with cardiac tamponade.

Primary cardiac lymphoma (PCL) is one of the rarest tumors and the most common type is large B-cell lymphoma. The right atrium and right ventricle are the most often involved, which should be diagnosed and treated in time. In this case, a female patient underwent an emergency surgical treatment for a large pericardial effusion and a huge mass in the right atrium. The huge mass was resected successfully. The pathological evaluation suggested that PCL and staging systemic chemotherapy were initiated according to the result, which significantly improve the prognosis of and quality of life.

Rare Intracardiac Tumor: Primary Cardiac Lymphoma Presenting as Atypical Angina.

Primary lymphomas of the heart are extremely rare, accounting for 2% of all primary cardiac tumors. Due to the rare presentation, there is no proper consensus available on treatment strategy. Preoperative confirmation of the pathology is fundamental in guiding an early treatment plan, which allows for improved prognosis. Unfortunately, in most cases, primary cardiac lymphoma is only identified on postoperative histopathological analyses, which affect the treatment plan and outcome. Here, we report a unique case of primary cardiac lymphoma presented with dyspnea and reduced effort tolerance. Young age, rapid onset of symptom, and absence of cardiac risk factors prompted us towards further imaging and emergency resection. The patient received a course of postoperative chemotherapy and was disease-free on six months of follow-up.

Primary Cardiac Lymphoma Presenting as an Atypical Type of Hypertrophic Cardiomyopathy

Primary cardiac lymphoma (PCL) is a very rare malignancy although cardiac involvement with the disseminated disease is not uncommon. We present a case of a 43-year-old man with PCL that initially presented as marked thickening of all cardiac walls and was mistakenly diagnosed as an atypical type of hypertrophic cardiomyopathy. The diagnosis of PCL was made with a delay of 9 months after the initial presentation, when atypical lymphocytes staining positive for CD79a and CD20 were demonstrated in the rapidly growing mediastinal and neck mass. Anthracycline-based chemotherapy and anti-CD20 immunotherapy resulted in a remarkable reduction in cardiac wall thickness and mediastinal mass. The first lesson to be learnt from this case is that PCL can present as a diffuse infiltrative disease without a mass. The second lesson is that prompt exploratory thoracotomy should not be delayed when the diagnosis is elusive.

Surgical resection of primary cardiac lymphoma presenting as a huge mass: report of two cases

Primary cardiac lymphoma (PCL) is a rare malignancy that is sometimes diagnosed at later stages because it is not associated with specific symptoms. Although chemotherapy is the standard for treating PCL, the value of surgical resection is controversial. We describe two patients who were treated by surgical resection and chemotherapy. Case 1 is a 37-year-old man with a history of acute lymphocytic leukemia and shortness of breath, and Case 2 is a 70-year-old woman with general fatigue. Both of them were presented at hospital. In Case 2, arrhythmic syncope occurred and direct current cardioversion was performed. Echocardiography showed a massive tumor in the right atrium and disturbed hemodynamics in both cases. The restricted venous return was alleviated by emergency surgery. The pathology report indicated primary cardiac lymphoma that was regressed by post-operative chemotherapy. A massive PCL should be surgically resected to prevent sudden death.

Cardiac Mass and Hypertrophic Cardiomyopathy as Aggressive Presentation of Primary Cardiac Lymphoma: A Case Report

Primary cardiac lymphoma is very rare. This disease occurs mainly in immunocompromised patients and rarely in the immunocompetent. With the advent of echocardiogram, computed tomography and magnetic resonance imaging, more cases are being diagnosed ante-mortem although the prognosis still remains poor. These cardiac tumors provide unique diagnostic and therapeutic challenges. We present an interesting case of primary cardiac lymphoma diagnosed antemortem in an 81 year old immunocompetent female presenting as a large mass in the right atrium, right ventricle and encasing the right coronary artery; and asymmetric left ventricular hypertrophy, a variant of hypertrophic cardiomyopathy. Patient responded very well to chemotherapy with subsequent regression of the cardiac mass and ventricular hypertrophy.

A case of primary cardiac lymphoma presenting with atrial fibrillation and acute heart failure

A case of primary cardiac lymphoma presenting with atrial fibrillation and acute heart failure

Primary Cardiac Lymphoma Presenting With Atrioventricular Block

Primary cardiac lymphomas (PCL) are extremely rare. Clinical manifestations may be variable and are attributed to location. Here, we report on a case of PCL presenting with atrioventricular (AV) block. A 55 year-old male had experienced chest discomfort with unexplained dyspnea and night sweating. His initial electrocardiogram (ECG) revealed a first degree AV block. Along with worsening chest discomfort and dyspnea, his ECG changed to show second degree AV block (Mobitz type I). Computed tomography (CT) scan showed a cardiac mass (about 7 cm) and biopsy was performed. Pathologic finding confirmed diffuse large B-cell lymphoma. The patient was treated with multi-drug combination chemotherapy (R-CHOP: Rituximab, cyclophoshamide, anthracycline, vincristine, and prednisone). After treatment, ECG changed to show normal sinus rhythm with complete remission on follow-up CT scan.

Unusual presentation of primary cardiac lymphoma

Cardiac lymphomas are rare neoplasms and account for a minor proportion of primary cardiac malignancies. Secondary involvement of the heart and pericardium by systemic lymphoma is well documented, but primary lymphomas of heart and pericardium are extremely rare, accounting for approximately 2% of all primary cardiac tumours. Most cases are diagnosed at autopsy, but nowadays, with modern imaging technologies, early diagnosis and treatment is possible. Here, we present two unique incidental presentations of primary cardiac lymphomas (PCL), one in an atrial myxoma and other involving a valvular homograft and discuss the potential pitfalls and prognosis of this rare entity.

Primary Cardiac Lymphoma Presenting with Cardiac Tamponade

Primary cardiac lymphoma (PCL) is rare and occurs more commonly in immunocompromised patients. It can present in various ways, and diagnosis is particularly challenging, especially for the unsuspecting physician. We report a case of PCL in an immunocompetent 55-year-old man who initially presented with pyrexia of unknown origin, chest pain, dyspnea, and few early clinical signs, but who was later found to have cardiac tamponade and a large cardiac mass on echocardiography and cardiovascular magnetic resonance. A high index of suspicion is needed to diagnose PCL, and echocardiogram remains an important diagnostic tool.

Primary Cardiac Lymphoma Presenting As Sick Sinus Syndrome

Primary Cardiac Lymphoma Presenting As Sick Sinus Syndrome

Primary cardiac lymphoma presenting with right heart mass and bradycardia

Primary cardiac lymphoma presenting with right heart mass and bradycardia

Primary cardiac lymphoma presenting as atrial flutter and total heart block

Primary cardiac lymphoma is extremely rare. We present the case of a 70-year-old man with primary cardiac lymphoma involving interatrial septum, presenting as atrial flutter and total heart block. The diagnosis was obtained by echocardiography-guided transvenous endocardial biopsy which revealed diffuse large B-cell non-Hodgkin's lymphoma, CD 20+. After six courses of immunochemotherapy the patient achieved complete remission. After 2 months he developed a series of epileptic attacks. Intracerebral lymphoma extension was diagnosed. Two cycles of high-dose methotrexate and cranial irradiation were applied, resulting in a second complete remission.

Surgical Treatment of a Primary Cardiac Lymphoma Presenting With Tamponade Physiology

Primary cardiac lymphomas (PCL) are rare cardiac neoplasms that carry an ominous prognosis. They occur more frequently in immunocompromised patients. We report on an immunocompetent 67-year-old who presented with dyspnea and dysphagia. Echocardiographic evidence of impending cardiac tamponade and obstruction of the inferior vena cava (IVC) with the tumor was seen. The deteriorating hemodynamics of our patient prompted an urgent surgical intervention. Pathohistological diagnosis showed diffuse large B-cell lymphoma of centroblastic subtype. Chemotherapy remains the standard treatment of PCL, with surgery reserved for relieving life-threatening complications of the neoplasm.

Primary Cardiac Lymphoma Presenting Clinically as Restrictive Cardiomyopathy

An unusual case of primary cardiac lymphoma presenting as restrictive cardiomyopathy with arrhythmia is reported in a 72-year-old woman who was admitted for evaluation of exertional dyspnea and palpitations. Electrocardiography (ECG) showed atrioventricular dissociation and right heart cardiac catheterization revealed a typical 'dip-and-plateau' waveform. Restrictive cardiomyopathy was suspected because computed tomography (CT) did not reveal pericardial thickening, calcifications, or an effusion. Heart failure initially improved with diuretic therapy, but subsequently worsened, and the patient experienced a syncopal episode. ECG showed atrial fibrillation, and CT revealed a large mass in the right atrium and multiple tumors in the liver, which needle biopsy confirmed as diffuse large B-cell lymphoma. Chemotherapy induced complete remission, and her heart failure markedly improved. The 'dip-and-plateau' waveform was no longer detected on repeat cardiac catheterization and the ECG showed restoration of sinus rhythm. Clinically, the diagnosis was primary cardiac lymphoma.

Right Atrial Primary Cardiac Lymphoma Presenting With Stroke

An immunocompetent 79-year-old man presented with acute dysarthria and hemiparesis on the left side. The cranial CT revealed the typical findings of a middle cerebral artery territory infarction of embolic origin, likely from previously unknown nonvalvular atrial fibrillation. The results of the duplex ultrasound of the carotid arteries were normal. Transesophageal echocardiography, however, showed a right atrial tumor, which suggested either thrombus or myxoma (Figure 1A, Movie I). No evidence of a thrombus or spontaneous echo contrast was observed in …

Linfoma cardíaco primario: presentación de un caso y revisión de la literatura

We describe a case of primary cardiac lymphoma presenting with chest pain, complete AV block, negative T waves, and infiltration of the basal segments and right free ventricular wall on echocardiography, interpreted initially as hypertrophy. One month later the patient was readmitted with systemic disease and cardiac insufficiency. Furthermore multicentric myocardial infiltration with a nodular mass in the right atrium producing severe tricuspid stenosis was demonstrated. Surgical biopsy was performed and a high grade non-Hodgkin's lymphoma diagnosed. The patient died during the immediate post-operative period without receiving specific chemotherapeutic treatment. Reviewing the published cases, we found that primary cardiac lymphomas are fast growing tumors that infiltrate predominantly the right cavities and have limited therapeutic options.