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Ozair S, Gerlach G, Patil N, Prasad KV. Arrhythmia as the presenting symptom of a primary cardiac lymphoplasmacytic lymphoma. HeartRhythm Case Rep 2024; 10:371-374. [PMID: 38799592 PMCID: PMC11116965 DOI: 10.1016/j.hrcr.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Affiliation(s)
- Sumair Ozair
- North Mississippi Medical Center, Tupelo, Mississippi
| | - Gene Gerlach
- North Mississippi Medical Center, Tupelo, Mississippi
| | - Neha Patil
- North Mississippi Medical Center, Tupelo, Mississippi
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2
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Sabzwari SRA, Tzou WS. Systemic Diseases and Heart Block. Cardiol Clin 2023; 41:429-448. [PMID: 37321693 DOI: 10.1016/j.ccl.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Systemic diseases can cause heart block owing to the involvement of the myocardium and thereby the conduction system. Younger patients (<60) with heart block should be evaluated for an underlying systemic disease. These disorders are classified into infiltrative, rheumatologic, endocrine, and hereditary neuromuscular degenerative diseases. Cardiac amyloidosis owing to amyloid fibrils and cardiac sarcoidosis owing to noncaseating granulomas can infiltrate the conduction system leading to heart block. Accelerated atherosclerosis, vasculitis, myocarditis, and interstitial inflammation contribute to heart block in rheumatologic disorders. Myotonic, Becker, and Duchenne muscular dystrophies are neuromuscular diseases involving the myocardium skeletal muscles and can cause heart block.
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Affiliation(s)
- Syed Rafay A Sabzwari
- University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Mail Stop B130, Aurora, CO 80045, USA
| | - Wendy S Tzou
- Cardiac Electrophysiology, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue, MS B-136, Aurora, CO 80045, USA.
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3
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Mao J, Xu Y, Zhu M, Wang L, Hou Y. Case report: Complete atrio-ventricular block successfully reversed in newly diagnosed primary cardiac B-cell lymphoma. Front Med (Lausanne) 2023; 10:1119286. [PMID: 37007783 PMCID: PMC10050578 DOI: 10.3389/fmed.2023.1119286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
Primary cardiac tumors are extremely uncommon and primary cardiac lymphoma (PCL) is an even rarer subset. A definite diagnosis can be delayed, which increases the likelihood of a poor prognosis. We report a case involving a 64-year-old male who presented with dyspnea, palpitation, and third-degree atrioventricular block (AVB) secondary to primary cardiac B-cell lymphoma that was diagnosed via endomyocardial biopsy (EMB) and multimodality imaging. Chemotherapy was initiated using rituximab, cyclophosphamide, vindesine, and prednisone (R-COP) followed by implantation of an artificial capsule pacemaker. Third-degree AVB vanished, and the subsequent cycle of treatment was adjusted as R-CDOP (rituximab, cyclophosphamide, doxorubicin liposome, vindesine, and prednisone), with aspirin and rosavastatin to prevent ischemic events. So far, the patient had a good clinical course and normal electrocardiogram. This case underscores the importance of EMB in the diagnosis of heart neoplasms. It is worth noting that anthracycline is not contraindicated in PCL.
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Affiliation(s)
- Jiahui Mao
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
| | - Yitong Xu
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
- Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital of Shandong University, Jinan, China
| | - Mingfang Zhu
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
- Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital of Shandong University, Jinan, China
| | - Luqun Wang
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
| | - Yu Hou
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
- Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital of Shandong University, Jinan, China
- *Correspondence: Yu Hou,
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Shigeno R, Okada T, Koyama T, Furukawa Y. Surgical resection and epicardial lead implantation for primary cardiac lymphoma with a complete atrioventricular block: a case report. Eur Heart J Case Rep 2023; 7:ytad035. [PMID: 36777149 PMCID: PMC9909755 DOI: 10.1093/ehjcr/ytad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/21/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
Background Primary cardiac lymphoma (PCL) is a rare cardiac tumour with various presentations, which might cause a complete atrioventricular (AV) block, which can, in turn, cause heart failure symptoms. Case summary We report a case of a 55-year-old woman with a chief complaint of exertional dyspnoea. Her vital signs showed bradycardia, and electrocardiography revealed a complete AV block. Transthoracic echocardiography revealed a large intra-cardiac mass in the right atrium. Full-body positron emission tomography showed an elevated fluorodeoxyglucose uptake in the right atrial mass, interatrial septum, and wall of the left atrium. Since the tumour could obstruct the tricuspid valve, urgent tumour debulking surgery and epicardial lead implantation were performed. Histopathological examination results were consistent with diffuse large B-cell lymphoma. After several courses of chemotherapy, we kept her in complete remission of the tumour for 2 years. Discussion Primary cardiac lymphoma was complicated by a complete AV block and diagnosed by using the samples that we obtained in the surgery. A surgical resection of the tumour and epicardial lead implantation, combined with chemotherapy, can be an option, especially in patients who require cardiac surgery.
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Affiliation(s)
- Ryo Shigeno
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe 6500047, Japan
| | - Taiji Okada
- Corresponding author. Tel: +81 78 302 4321, Fax: +81 78 302 7537,
| | - Tadaaki Koyama
- Department of Cardiothoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
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5
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Qiang Y, Zeng K, Zhang B, Guan R, Liu Y, Liu Z, Xu H, Zhang X, Ren Y, Deng B, Yang Y. Atypical location of primary cardiac lymphoma in the left heart with atypical clinical presentation: A case report and literature review. Front Surg 2023; 9:1036519. [PMID: 36726943 PMCID: PMC9885797 DOI: 10.3389/fsurg.2022.1036519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/24/2022] [Indexed: 01/18/2023] Open
Abstract
Background Primary cardiac lymphoma (PCL) is a rare and aggressive cardiac tumor with very poor prognosis that occurs mostly in the right cardiac cavity. Early diagnosis and treatment may improve its prognosis. In the present report, we describe the diagnosis and treatment of a primary cardiac diffuse large B-cell lymphoma (PC-DLBCL) with atypical location and clinical presentation. Additionally, a literature review was conducted to summarize the current knowledge of the disease. Case Presentation A 71-year-old man visited his local hospital because of syncope, recurrent chest tightness, shortness of breath, palpitations, and profuse sweating for more than 20 days. Chest radiography revealed a mediastinal mass. Cardiac computed tomography (CT) showed multiple enlarged mediastinal lymph nodes. Transthoracic echocardiography (TTE) showed a cardiac mass in the posterior-inferior wall of the left atrium. He was then transferred to our hospital for positron emission tomography-CT (PET-CT) which showed active uptake of fluorodeoxyglucose both in the cardiac mass and in the multiple enlarged mediastinal lymph nodes. Biopsy of the enlarged mediastinal lymph nodes was carried out by using video-assisted thoracic surgery (VATS) technique, and pathological examination confirmed the subtype of PC-DLBCL, Stage IV, NCCN IPI 3. Therefore, the patient received a combination of chemotherapy and immunotherapy with R-CDOP (rituximab, cyclophosphamide, liposome doxorubicin, vincristine, and prednisone). After four courses of treatment in 4 months, the cardiac lymphoma and the enlarged mediastinal lymph nodes achieved complete remission with mild side effects of the chemotherapy. Conclusion Early diagnosis and a precise choice of chemotherapy and immunotherapy based on cardiac imaging and pathological examination may improve the prognosis of PC-DLBCL in an atypical location.
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Affiliation(s)
- Yongjia Qiang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Kuan Zeng
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Bin Zhang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China,Guangdong Provincial Key Laboratory of Epigenetics and Gene Regulation of Malignant Tumors, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Ruicong Guan
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China,Guangdong Provincial Key Laboratory of Epigenetics and Gene Regulation of Malignant Tumors, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Yuqiang Liu
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Zhuxuan Liu
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Haohua Xu
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Xinyi Zhang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Yanting Ren
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Baoping Deng
- Department of Vascular Surgery, The Fifth Affiliated Hospital, Southern Medical University, Guangdong, China,Correspondence: Yanqi Yang Baoping Deng
| | - Yanqi Yang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China,Department of Cardiothoracic Surgery, University Hospital, Linköping University, Linköping, Sweden,Correspondence: Yanqi Yang Baoping Deng
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6
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Hu B, Zhao J, Liang X, Ren C, Li N, Liang C. A case of complete atrioventricular block associated with primary cardiac lymphoma reversed without cardiac pacemaker implantation. J Int Med Res 2022; 50:3000605221089780. [PMID: 35387513 PMCID: PMC9003660 DOI: 10.1177/03000605221089780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Primary cardiac lymphoma (PCL) is a rare malignant lymphoma that is characteristically confined to the heart and/or pericardium. Here, the case of a 70-year-old male patient with complete atrioventricular block (AVB) associated with PCL is presented. The patient had a 10-month history of palpitation and electrocardiogram (ECG) showed a complete AVB. Additionally, transthoracic echocardiography indicated pericardial effusion where atypical lymphoid cells were identified by pericardiocentesis. Subsequent mediastinal lymph node biopsy revealed non-germinal centre diffuse large B-cell lymphoma. Therefore, a diagnosis of PCL was confirmed. As the patient’s vital signs were stable, he was prescribed chemotherapy without pacemaker implantation. After chemotherapy, the patient achieved remission and dynamic ECG demonstrated no recurrence of AVB. The present case demonstrates that although PCL initially manifesting as complete AVB is rare, this possibility should not be ignored when a new AVB without definite aetiology is encountered. In addition, if the vital signs of the patient are stable, pacemaker implantation may be postponed until the treatment effect of chemotherapy has been assessed.
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Affiliation(s)
| | | | | | | | | | - Chun Liang
- Chun Liang, Department of Cardiology, Shanghai Changzheng Hospital, the Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Huangpu, Shanghai 200003, China. E-mail:
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7
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Abstract
Systemic diseases can cause heart block owing to the involvement of the myocardium and thereby the conduction system. Younger patients (<60) with heart block should be evaluated for an underlying systemic disease. These disorders are classified into infiltrative, rheumatologic, endocrine, and hereditary neuromuscular degenerative diseases. Cardiac amyloidosis owing to amyloid fibrils and cardiac sarcoidosis owing to noncaseating granulomas can infiltrate the conduction system leading to heart block. Accelerated atherosclerosis, vasculitis, myocarditis, and interstitial inflammation contribute to heart block in rheumatologic disorders. Myotonic, Becker, and Duchenne muscular dystrophies are neuromuscular diseases involving the myocardium skeletal muscles and can cause heart block.
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8
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Asadian S, Rezaeian N, Hosseini L, Toloueitabar Y, Hemmati Komasi MM. The role of cardiac CT and MRI in the diagnosis and management of primary cardiac lymphoma: A comprehensive review. Trends Cardiovasc Med 2021; 32:408-420. [PMID: 34454052 DOI: 10.1016/j.tcm.2021.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/05/2021] [Accepted: 08/20/2021] [Indexed: 12/18/2022]
Abstract
Primary cardiac tumors comprise a distinct category of disorders that result in significant cardiac complications. Primary cardiac lymphomas (PCLs) constitute the second most frequent primary malignancy involving the heart. Without treatment, survival may be limited to just a few months; however, a timely therapeutic schedule may prolong the five-year survival. Accordingly, robust diagnostic modalities are essential to improve prognosis. We herein review the literature available in PubMed, MEDLINE, Cochrane, Google Scholar and Scopus databases. Our review demonstrated that cardiac computed tomography (CT) and magnetic resonance imaging (MRI) employ multiple advanced sequences for tumor characterization with or without a contrast agent. These methods assist not only in differentiating PCLs from other cardiac masses such as cardiac thrombi but also in defining the extent of PCLs and conducting a safe biopsy. Cardiac magnetic resonance (CMR) and CT imaging provide essential knowledge regarding PCLs and cardiotoxicity induced by therapeutic regimens. The application of these robust imaging modalities aids in the early diagnosis of PCLs, accelerates the initiation of the treatment program, and improves patient outcomes significantly. Also presented is our introduction into novel techniques and the feasibility of their use to diagnose and treat cardiac masses, particularly PCLs. It should be mentioned that the paramount role of FDG-PET was not the focus of this paper.
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Affiliation(s)
- Sanaz Asadian
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Nahid Rezaeian
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran.
| | - Leila Hosseini
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
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9
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Tazi I, Benmoussa A, Boufarissi FZ, Sifsalam M, Lahlimi FZ. [Non-Hodgkin cardiac lymphomas]. Ann Cardiol Angeiol (Paris) 2021; 70:237-244. [PMID: 34274110 DOI: 10.1016/j.ancard.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
Cardiac non-Hodgkin lymphoma (CNHL) is a rare extranodal lymphoma with a poor prognosis. Secondary cardiac lymphoma is more frequent than primary cardiac lymphoma. CNHL often involves the right side of the heart. Diagnosis of CNHL can be suggested by echocardiography and magnetic resonance imaging. Cytological examination of pericardial fluid or histological of cardiac tissue is essential. The majority of cases are diffuse B-cell lymphoma. A prompt immediate diagnosis and early treatment are essential for better outcome. Management should be individualized and the most effective treatment is chemotherapy containing anthracycline variably combined with radiotherapy. A multidisciplinary approach is essential to the successful treatment of CNHL.
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Affiliation(s)
- I Tazi
- Service d'hématologie clinique, faculté de médecine, université Cadi Ayyad, CHU Mohamed VI, Marrakech, Maroc.
| | - A Benmoussa
- Service d'hématologie clinique, faculté de médecine, université Cadi Ayyad, CHU Mohamed VI, Marrakech, Maroc
| | - F Z Boufarissi
- Service d'hématologie clinique, faculté de médecine, université Cadi Ayyad, CHU Mohamed VI, Marrakech, Maroc
| | - M Sifsalam
- Service d'hématologie clinique, faculté de médecine, université Cadi Ayyad, CHU Mohamed VI, Marrakech, Maroc
| | - F Z Lahlimi
- Service d'hématologie clinique, faculté de médecine, université Cadi Ayyad, CHU Mohamed VI, Marrakech, Maroc
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10
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Amin A, Chitsazan M, Ghavidel AA, Pouraliakbar H, Parsaee M, Khesali H. A rare cause of complete heart block in an adult: Primary cardiac lymphoma. Asian Cardiovasc Thorac Ann 2021; 30:321-324. [PMID: 33726549 DOI: 10.1177/02184923211001697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary cardiac lymphoma (PCL) is a rare primary cardiac neoplasm with a relatively poor prognosis despite confinement to the heart and/or pericardium. We report a 54-year-old man who had presented with complete heart block for which he had undergone permanent pacemaker implantation, and six months later he was referred to us for evaluation of progressive exertional dyspnea. Multislice spiral computed tomography angiography of the heart and major vasculature showed infiltrative tumoral lesion that has involved interatrial septum, right atrium, left atrium, and left ventricle with invasion into the pulmonary artery. Tissue samples were taken using uniportal video-assisted thoracoscopic surgery, and the histologic examination revealed diffuse large B-cell lymphoma. Chemoimmunotherapy was effective in inducing tumor regression and the patient was still in remission during the next six months after treatment.
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Affiliation(s)
- Ahmad Amin
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mitra Chitsazan
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Alizadeh Ghavidel
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pouraliakbar
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mozhgan Parsaee
- Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamideh Khesali
- Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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11
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Morgan HP, El-Nayir M, Jenkins C, Campbell PG. Complete heart block as a herald sign for cardiac lymphoma. BMJ Case Rep 2021; 14:14/1/e239356. [PMID: 33431472 PMCID: PMC7802647 DOI: 10.1136/bcr-2020-239356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
A previously well 48-year-old man presented with presyncope and was found to be in complete heart block. Blood tests, echocardiography and coronary angiography were reported as normal, and a dual chamber permanent pacemaker was inserted. Six months later he re-presented with breathlessness. His chest X-ray showed cardiomegaly and echocardiography revealed a 4.4 cm pericardial effusion. A CT thorax revealed a mass originating from the intra-atrial septum, extending into the right atrium and ventricle. There were multiple pulmonary lesions suspected to be metastases. Histology demonstrated high-grade B-cell lymphoma. He was treated with eight cycles of R-CHOP chemotherapy and showed good radiological and clinical improvement. Post-treatment echocardiography found severe left ventricular dysfunction with an ejection fraction of <20%. Heart failure medical therapy was optimised and the pacemaker was upgraded to a resynchronisation device. A repeat scan 6 months post device upgrade showed an improvement in ejection fraction to 45%-50%.
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Affiliation(s)
- Holly P Morgan
- Cardiology, Royal Gwent Hospital, Newport, South Wales, UK
| | - Muram El-Nayir
- Cardiology, Royal Gwent Hospital, Newport, South Wales, UK
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12
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Jang GW, Chung H, Kim WS, Lee JM. Primary Cardiac Lymphoma Manifesting as an Atrioventricular Block in a Renal Transplantation Recipient. JACC Case Rep 2020; 2:600-603. [PMID: 34317303 PMCID: PMC8298532 DOI: 10.1016/j.jaccas.2020.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/29/2020] [Indexed: 11/28/2022]
Abstract
Our report illustrates an atrioventricular block due to primary cardiac lymphoma attached to the right atrial septum that was rapidly reversible by surgical debulking and effective chemotherapy without the need for a permanent pacemaker. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Gyeong-Won Jang
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Medical College, Kyung Hee University, Seoul, Republic of Korea
| | - Hyemoon Chung
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Medical College, Kyung Hee University, Seoul, Republic of Korea
| | - Woo-Shik Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Medical College, Kyung Hee University, Seoul, Republic of Korea
| | - Jung Myung Lee
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Medical College, Kyung Hee University, Seoul, Republic of Korea
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13
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Primary Cardiac Lymphoma Manifesting as Complete Heart Block. Case Rep Cardiol 2020; 2020:3825312. [PMID: 33062338 PMCID: PMC7537681 DOI: 10.1155/2020/3825312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 01/16/2020] [Indexed: 11/17/2022] Open
Abstract
Primary cardiac tumors are exceedingly rare with variable clinical manifestations. This case involves a patient presentation of symptomatic complete heart block and cardiac imaging revealing a right atrial mass invading the myocardium consistent with Burkitt lymphoma on histopathology. The patient received definitive bradytherapy with a pacemaker and chemotherapy for the primary cardiac lymphoma. After three cycles of chemotherapy, the right atrial mass regressed significantly with restoration of atrioventricular conduction and no pacing burden. Primary cardiac lymphomas infrequently manifest as atrioventricular block and this case highlights cardiac masses as a potential etiology when evaluating new conduction disturbances and bradyarrhythmias.
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14
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Kim S, Kim YR, Choi Y, Kim SH, Oh YS. A Long Journey to the Truth: Primary Cardiac Lymphoma with Various Arrhythmias from Ventricular Tachycardia to Atrial Flutter. Korean Circ J 2019; 50:374-378. [PMID: 31960642 PMCID: PMC7067610 DOI: 10.4070/kcj.2019.0298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/11/2019] [Accepted: 11/26/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sunhwa Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoo Ri Kim
- Division of Cardiology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Young Choi
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Seog Oh
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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15
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Goujeau C, Garcia R, Dufour M, Christiaens LP. Cardiac pacing for complete atrioventricular block complicating heart lymphoma: A challenging issue. Presse Med 2018; 47:833-834. [PMID: 29933920 DOI: 10.1016/j.lpm.2018.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/24/2018] [Accepted: 05/16/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Cyril Goujeau
- La Rochelle hospital, Cardiology department, Dr Schweitzer street, 17000 La Rochelle, France.
| | - Rodrigue Garcia
- Cardiac Electrophysiology department, Poitiers University Hospital, 86021 Poitiers, France.
| | - Maxence Dufour
- Cardiac Electrophysiology department, Bordeaux University Hospital, 33604, Pessac, France.
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16
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Abstract
Lymphoma of the heart and pericardium may develop in up to 25% of patients with disseminated nodal disease, but primary cardiac lymphoma is rare. The majority are diffuse large B-cell lymphomas, which arise in immunocompetent older individuals, men twice as often as women. Subsets are found in immunocompromised patients, including those with HIV-AIDS or allograft recipients. Cardiac lymphomas tend to arise in the wall of the right heart, especially right atrium, with contiguous infiltration of epicardium and pericardium. Pericardial implants and effusions are common. The disease is often multifocal in the heart, but cardiac valves are usually spared.
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Affiliation(s)
- Jean Jeudy
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Allen P Burke
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Aletta Ann Frazier
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA; American Institute for Radiologic Pathology, 1010 Wayne Avenue, Silver Spring, MD, USA.
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17
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Primary Cardiac Lymphoma: Lessons Learned from a Long Survivor. Case Rep Cardiol 2016; 2016:7164829. [PMID: 28053792 PMCID: PMC5174167 DOI: 10.1155/2016/7164829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 09/25/2016] [Indexed: 11/17/2022] Open
Abstract
Primary cardiac lymphoma (PCL) is a rare neoplasm that involves the heart, pericardium, or both. Patients with PCL have median survival of approximately 7 months. We report a 63-year-old woman with PCL treated with chemoimmunotherapy but relapsed 7 years later. She received automated implantable cardioverter-defibrillator (AICD) prophylactically shortly after the diagnosis. She presented with a breast recidive 7 years after initial diagnosis and died of relapsed small cell lung cancer. As many patients with PCL die early in the disease course due to life-threatening arrhythmias, preemptive implantation of AICD may improve mortality and prevent early death. Chemoimmunotherapy is effective in inducing remission in patients with PCL. Late and unusual pattern of relapse may be more frequent in patients with PCL and should be explored further. This case presents one of the longest surviving patients with PCL reported in the literature.
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18
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Takahashi A, Otsuka H, Harada M. Multimodal Cardiovascular Imaging of Cardiac Tumors. ACTA ACUST UNITED AC 2016. [DOI: 10.17996/anc.02.01.61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ayaka Takahashi
- Department of Radiology, Tokushima University Graduate School
| | - Hideki Otsuka
- Department of Medical Imaging / Nuclear Medicine, Tokushima University Graduate School
| | - Masafumi Harada
- Department of Radiology, Tokushima University Graduate School
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19
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Jeudy J, Kirsch J, Tavora F, Burke AP, Franks TJ, Mohammed TL, Frazier AA, Galvin JR. From the radiologic pathology archives: cardiac lymphoma: radiologic-pathologic correlation. Radiographics 2013; 32:1369-80. [PMID: 22977025 DOI: 10.1148/rg.325115126] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
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.
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Affiliation(s)
- Jean Jeudy
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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20
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21
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Miguel CE, Bestetti RB. Primary cardiac lymphoma. Int J Cardiol 2011; 149:358-63. [DOI: 10.1016/j.ijcard.2010.02.016] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 02/10/2010] [Accepted: 02/10/2010] [Indexed: 11/26/2022]
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22
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Primary breast lymphoma with sudden death. Am J Forensic Med Pathol 2011; 32:176-9. [PMID: 21512383 DOI: 10.1097/paf.0b013e318219c8a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary breast lymphoma is a rare form of extranodal lymphoma. B cells constitute the most common type involving the breast. T cells represents only 3%. Even though lymphomas have a high predilection to metastasize to the heart, there are no specific clinical or radiological findings, and most of the cases are diagnosed at autopsy. We discuss the case of a 49-year-old woman with primary breast lymphoma who presented with sudden death. Autopsy revealed a primary T-cell lymphoma of the breast with tumoral infiltration of the atrioventricular node and transmural myocardial permeation with focal necrosis.
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23
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Cho SW, Kang YJ, Kim TH, Cho SK, Hwang MW, Chang W, Rhee KJ, Kim BO, Goh CW, Park KM, Kim JH, Byun YS, Yuh YJ. Primary cardiac lymphoma presenting with atrioventricular block. Korean Circ J 2010; 40:94-8. [PMID: 20182596 PMCID: PMC2827810 DOI: 10.4070/kcj.2010.40.2.94] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 09/17/2009] [Accepted: 09/24/2009] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Sung Woo Cho
- Department of Internal Medicine, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
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24
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Lin JN. Cardiac lymphoma with first manifestation of recurrent syncope-a case report and literature review. Int Med Case Rep J 2010; 3:1-6. [PMID: 23754880 PMCID: PMC3658218 DOI: 10.2147/imcrj.s9269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cardiac involvement, as an initial presentation of malignant lymphoma is rare. We report a 42-year-old Taiwanese man with frequent syncope. Routine electrocardiography disclosed complete atrioventricular block. Before permanent pacemaker implantation was undertaken, transthoracic echocardiography revealed a solid mass infiltrating the left atrium and interatrial septum. Transesophageal echocardiography proved cardiac neoplasm with biatrial infiltration. Endomyocardial tissue biopsy was performed under angiography guide. Pathology diagnosis unraveled large B-cell lymphoma. Despite aggressive chemotherapy, the patient’s condition worsened and he died 2 months later.
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Affiliation(s)
- Joseph Nybo Lin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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25
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Tanaka Y, Yamabe H, Yamasaki H, Tsuda H, Nagayoshi Y, Kawano H, Kimura Y, Hokamura Y, Ogawa H. A case of reversible ventricular tachycardia and complete atrioventricular block associated with primary cardiac B-cell lymphoma. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:816-9. [PMID: 19545348 DOI: 10.1111/j.1540-8159.2009.02372.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a long-term survival case of primary cardiac lymphoma with reversible ventricular tachycardia (VT) and complete atrioventricular block (C-AVB). A 65-year-old man with VT was treated by oral amiodarone administration. Later, a dual-chamber pacemaker was implanted because of C-AVB. Then, he was readmitted, as he complained of fever and chest pain. Echocardiography showed an enlarged cardiac mass and thus an open-chest biopsy was performed. He was then diagnosed with primary cardiac lymphoma. The chemotherapy and radiotherapy resulted in the disappearance of the mass. Complete remission has been maintained for 8 years after the therapy, and no VT or C-AVB has been detected.
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Affiliation(s)
- Yasuaki Tanaka
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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26
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Antoniades L, Eftychiou C, Petrou PM, Bagatzounis A, Minas M. Primary Cardiac Lymphoma: Case Report and Brief Review of the Literature. Echocardiography 2009; 26:214-9. [DOI: 10.1111/j.1540-8175.2008.00757.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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27
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SUGIYAMA A, TAKEUCHI T, MORITA T, MATSUU A, KANDA T, SHIMADA A, AMAYA T, HIKASA Y. Mediastinal Lymphoma with Complete Atrioventricular Block in a Horse. J Vet Med Sci 2008; 70:1101-5. [DOI: 10.1292/jvms.70.1101] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Akihiko SUGIYAMA
- Department of Veterinary Laboratory Medicine, School of Veterinary Medicine, Faculty of Agriculture, Tottori University
| | - Takashi TAKEUCHI
- Department of Veterinary Laboratory Medicine, School of Veterinary Medicine, Faculty of Agriculture, Tottori University
| | - Takehito MORITA
- Department of Veterinary Pathology, School of Veterinary Medicine, Faculty of Agriculture, Tottori University
| | - Aya MATSUU
- Department of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Agriculture, Tottori University
| | - Teppei KANDA
- Department of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Agriculture, Tottori University
| | - Akinori SHIMADA
- Department of Veterinary Pathology, School of Veterinary Medicine, Faculty of Agriculture, Tottori University
| | | | - Yoshiaki HIKASA
- Department of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Agriculture, Tottori University
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28
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Nascimento AF, Winters GL, Pinkus GS. Primary cardiac lymphoma: clinical, histologic, immunophenotypic, and genotypic features of 5 cases of a rare disorder. Am J Surg Pathol 2007; 31:1344-50. [PMID: 17721189 DOI: 10.1097/pas.0b013e3180317341] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary lymphomas of the heart are rare and frequently are diagnosed at autopsy. Modern imaging technology now permits early diagnosis and treatment. This report describes the clinical, histologic, immunophenotypic, and molecular genetic findings for 5 patients with malignant lymphoma restricted to the cardiac muscle, with or without pericardial involvement. All patients were women, with ages ranging from 40 to 68 years (median 55 y). The right atrium was involved in all cases with the left atrium, right ventricle, and pericardium affected in 1 case each. Clinical presentation included pericardial effusions associated with precordial pain, dyspnea, and bradycardia. Electrocardiographic changes included junctional rhythm, incomplete right bundle branch block and ST and T waves abnormalities, and ST segment elevation and first-degree atrioventricular block with intermittent complete heart block. In all cases, biopsy or resection of the lesion or cytologic examination of the pericardial fluid established a diagnosis. All tumors were of B-cell phenotype and included 4 cases of large cell lymphoma and one unclassifiable small cell lymphoma. In 2 cases, a follicular center cell origin was supported by reactivity of the neoplastic cells for CD10 and bcl-6 and by bcl-2 gene rearrangement by molecular analysis. One patient died shortly after diagnosis due to cerebral infarction. Two patients are alive without disease after chemotherapy with CHOP after 120 and 192 months. One patient underwent chemotherapy with CHOP and rituximab, and shows persistent cardiac involvement by lymphoma but with a decrease in tumor burden at 7 months of follow-up. One patient was lost to follow-up. Clinical outcome is variable; however, early diagnosis in conjunction with effective treatment (surgery and/or chemotherapy) may result in an excellent prognosis. Primary cardiac lymphoma should be included in the differential diagnosis of a right atrial mass.
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MESH Headings
- Adult
- Aged
- Antigens, CD/analysis
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/therapeutic use
- Diagnosis, Differential
- Doxorubicin/administration & dosage
- Doxorubicin/therapeutic use
- Female
- Gene Expression Regulation, Neoplastic
- Gene Rearrangement
- Genotype
- Heart Atria/pathology
- Heart Neoplasms/diagnosis
- Heart Neoplasms/drug therapy
- Heart Neoplasms/genetics
- Heart Neoplasms/immunology
- Heart Neoplasms/pathology
- Heart Ventricles/pathology
- Humans
- Immunophenotyping
- Karyotyping
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Middle Aged
- Pericardium/pathology
- Prednisone/administration & dosage
- Prednisone/therapeutic use
- Treatment Outcome
- Vincristine/administration & dosage
- Vincristine/therapeutic use
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Affiliation(s)
- Alessandra F Nascimento
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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29
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Hwang YY, Fan K, Lam YM, Chan WS, Cheung S, Wang EP, Au WY. Primary cardiac lymphoma presenting with right heart mass and bradycardia. Ann Hematol 2007; 86:685-6. [PMID: 17453210 DOI: 10.1007/s00277-007-0285-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Accepted: 03/05/2007] [Indexed: 11/26/2022]
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30
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Matsuo S, Sato Y, Miyamoto A, Nakae I, Saeki M, Hodohara K, Horie M. Primary malignant lymphoma of the right atrium resulting in superior vena caval syndrome in an HIV-positive patient: depiction at multislice computed tomography and magnetic resonance imaging. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2006; 7:255-7. [PMID: 17174876 DOI: 10.1016/j.carrev.2006.03.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Accepted: 03/31/2006] [Indexed: 10/23/2022]
Abstract
An HIV-positive 32-year-old male presenting with superior vena cava syndrome underwent multislice computed tomography (MSCT) and magnetic resonance imaging (MRI), which showed a large tumor in the right atrium, which extended to the superior vena cava. Pathologic examination revealed that the mass was consistent with B cell-type malignant lymphoma. The tumor size markedly decreased after the initiation of chemotherapy and patient recovery has been uneventful for 1 year.
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Affiliation(s)
- Shinro Matsuo
- Department of Cardiovascular-Respiratory Medicine, Shiga University of Medical Science, Shiga 520-2192, Japan.
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31
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Abstract
Primary cardiac lymphoma (PCL) has rarely been reported in Chinese populations. PCL mostly occurs in the right atrium. The clinical manifestations may be variable and are attributed to its location, the presence of congestive heart failure, pericardial effusion, arrhythmia, and cardiomegaly. The prognosis is usually poor because it is usually found too late and therefore, clinicians should be aware of PCL. Imaging examinations are the best methods for initial diagnosis and include echocardiography, computed tomography (CT) scan, magnetic resonance imaging (MRI), and radioisotope scan. However, the final diagnosis is made by pathology, such as cytologic examination of the effusive fluid and tissue biopsy. Because the tumors are difficult to resect, the main treatment for the disease is chemotherapy, which can be successful. Here, we report a 58-year-old man who had a tumor measuring 8 x 5 cm in the right atrium. By clinical staging, including chest X-ray, echocardiography, CT scan of the abdomen, MRI of the heart, whole body tumor Gallium scan, and gastrointestinal series, no metastatic lesion or involvement was found in other parts of the body. Pathologic findings including cytology of pericardial effusion and heart tumor biopsy revealed the case as a diffuse large B-cell lymphoma. After chemotherapy with COP (cyclophosphamide + vincristine + prednisone) and CHOPBE (COP + doxorubicin + bleomycin + etoposide) regimens, the intracardiac tumor had disappeared, but the patient survived for 12 months in total, despite additional radiotherapy over the pericardial lesions. It was presumed that because the tumor was very large and involved all 3 layers of the heart, it did not respond as well to the therapy as expected.
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Affiliation(s)
- Shu-Ching Hsueh
- Division of Hematology/Oncology, Department of Internal Medicine, Cheng-Hsin Rehabilitation and Medical Center, Taipei, Taiwan, ROC.
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32
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Engelen MA, Bruch C, Buerger H, Weckesser M, Hoffmeier A. Pericarditis Constrictiva and High-degree Atrioventricular Block as a First Manifestation of a Cardiac B-cell Lymphoma. J Am Soc Echocardiogr 2005; 18:694. [PMID: 15947778 DOI: 10.1016/j.echo.2004.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Primary cardiac lymphoma is an extremely rare extranodal non-Hodgkin's lymphoma, exclusively located in the heart and/or the pericardium with no evidence of extracardiac dissemination. In this report, we describe a cardiac B-cell lymphoma arising in a 70-year-old woman who presented to the hospital with heart failure symptoms and a high-degree atrioventricular block of unknown origin. Echocardiography revealed a massive infiltrative thickening of the atrial septum, the aortic root, and the pericardium. Pulsed wave and Doppler tissue findings were highly suggestive for pericarditis constrictiva. Positron emission tomography showed unusually strong metabolic activity in the atrial septum, both atria, and the entire pericardium. Suggested malignoma was confirmed by the pericardial biopsy specimens, which revealed a high-grade diffuse CD20+ B-cell lymphoma.
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Affiliation(s)
- Markus A Engelen
- Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany
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33
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Lo SS, Yeager AM, Peel RL, Katz WE, Ramanathan RK. Multimodality treatment in a case of primary cardiac lymphoma. ACTA ACUST UNITED AC 2004; 4:112-4. [PMID: 14556683 DOI: 10.3816/clm.2003.n.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary cardiac lymphoma(PCL) is an exceptionally rare entity associated with a poor progonosis. The patient in this report underwent successful surgical resection of a PCL. We now describe her multimodality treatment including autologous stem cell transplantation which resulted in a 22 month survival.
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Affiliation(s)
- Shelly S Lo
- University of Pittsburgh Cancer Institute, Pittsburgh, PA 15232, USA
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34
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Abstract
Primary cardiac lymphoma is a very rare malignancy, which is typically of a non-Hodgkin type, and involves only the heart and pericardium with no or minimal evidence of extracardiac involvement. Primary cardiac lymphoma account for about 1% of the primary cardiac tumors and 0.5% of the extranodal lymphomas. On the other hand, disseminated lymphoma with cardiac involvement can occur in up to 20% of patients with lymphoma. About 80% of cases of the primary cardiac lymphoma in immunocompetent hosts are of diffuse B-cell lymphoma, and in patients with immunodeficiency states, small noncleaved or immunoblastic lymphomas are more frequent. The right atrium and right ventricle are the 2 most frequently involved sites. Clinical presentation is heterogeneous and is generally related to the site of involvement in the heart. The diagnosis is suspected when patients present with a cardiac mass or an unexplained refractory pericardial effusion. A thorough workup should include transthoracic and transesophageal echocardiography, computed tomography, and magnetic resonance imaging. Diagnosis is confirmed by cytology of the serous fluid from pericardial or pleural effusion or biopsy of the pericardial mass or endomyocardial tissue. The exploratory thoracotomy should not be delayed if indicated. Chemotherapy has been used alone or combined with radiotherapy. Similarly, palliative cardiac surgery has been performed, mainly for tumor debulking. Combination of chemotherapy and radiation therapy is considered as the treatment of choice. The survival is generally less than a month without treatment but has been prolonged up to 5 years with palliative treatments in selected cases.
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Affiliation(s)
- Ramesh M Gowda
- Division of Cardiology, Long Island College Hospital, Brooklyn, NY, USA
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