Primary cardiac lymphoma

Constrictive Pericarditis–A Cloak Camouflaging Lymphoma

Non-Hodgkin’s lymphoma presenting as a primary cardiac lymphoma (PCL) is extremely unusual. Having a predilection for the right side of the heart and accounting for 1% of all cardiac tumours, the difficulty in diagnosing the lesion, owing to the location and vague presenting symptoms and signs, often leads to delayed diagnosis and poor prognosis. In our case report, a middle-aged male was diagnosed with PCL presenting as pyrexia of unknown origin with the help of F18-fluorodeoxyglucose positron emission tomography (18 FDG-PET). PET-CT is an invaluable tool in patients with pyrexia of unknown origin (PUO), especially caused by neoplasms as it helps in localizing the target lesion, aiding in selecting the appropriate intervention for rapid tissue diagnosis. This case serves to sensitize the physicians of PCL presenting with PUO and mimicking a relatively common cardiac tumour such as atrial myxoma.

A rare primary pericardial DLBCL masquerading as an unexplained malignant pleural effusion in an elderly woman: A case report

Introduction

Primary cardiac lymphoma (PCL) is an extremely rare and fatal heart neoplasm. Primary cardiac non-Hodgkin lymphoma (NHL) is uncommon, considering the rarity of pericardial diffuse large B-cell lymphoma (DLBCL) with advanced pleural metastasis.

Case presentation

We reported an 86-year-old female with primary pericardial DLBCL diagnosed initially by pleural effusion cytology. The chest imaging study revealed multiple pericardial lobulated infiltrative masses and epicardial invasion. Subsequently, she underwent an emergent pericardial window with a pericardial mass biopsy. The final histopathological and immunohistochemical (IHC) stain confirmed primary pericardial DLBCL, initially showing unexplained malignant pleural effusion.

Clinical discussion

The presence and extent of tumour invasion in the heart can be confirmed by echocardiography, computerised tomography (CT), or magnetic resonance imaging (MRI). However, the final histopathological diagnosis requires an examination of the endocardial, myocardial, pericardial window and biopsy or pericardial and pleural effusion cytology. This is the first case report of primary pericardial DLBCL diagnosed by metastatic malignant pleural effusion cytology per the literature review.

Conclusion

The definitive diagnosis for primary pericardial DLBCL is based on effusion cytology, histopathological and IHC evaluation, and clinical characteristics and image feature correlation.

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Primary pericardial NHL in immunocompromised individuals is a rare entity of an aggressive extranodal lymphoma.

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Pericardial DLBCL is a rare NHL with malignant pleural effusions significantly characterised by a poor prognosis.

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Malignant pleural effusion and supportive care retained significance in the multivariate analysis.

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Diagnosis is based on the effusion cytology and histopathological evaluations and clinical and image features correlation.

Multimodality Imaging Guided Diagnosis and Treatment Response Evaluation in a Patient with Lymphoma with Right Atrioventricular Involvement

A 42-year-old female was transferred to our center from a regional hospital with 5-day history of flushing, fatigue, and chest pressure. On initial presentation to the regional hospital, computed tomography (CT) of chest revealed a large mediastinal mass with cardiac involvement. Supraclavicular lymph node biopsy demonstrated non-germinal center diffuse large B-cell lymphoma with Ki67 index near 100%. A transthoracic echocardiogram (TTE) revealed a solid mass infiltrating the right atrium (RA) and right ventricle (RV), moderate tricuspid regurgitation, and a moderate pericardial effusion. Further assessment with cardiac magnetic resonance (CMR) imaging demonstrated a contrast avid mass with necrotic center invading into the RA and RV consistent with metastatic lymphoma. Prior to induction chemotherapy, her clinical course was complicated by supraventricular tachycardia that resolved after initiation of targeted chemotherapy against the lymphoma. Follow-up cardiac imaging 3 months later demonstrated decrease in size of the cardiac mass and the amount of pericardial effusion. This case demonstrates utility of multi-modality cardiac imaging in the diagnosis and assessing therapeutic response of diffuse large B-cell Lymphoma with cardiac involvement.

Primary cardiac lymphoma in HIV infected patients: A clinicopathological report of two cases

INTRODUCTION AND IMPORTANCE

Due to advances in diagnostic methods and human immunodeficiency virus, there has been a recent increase in cardiac involvement by lymphoma.

CASE PRESENTATION CASE 1

15-year-old HIV infected male patient presented with features of heart failure and cardiac tamponade. The transthoracic echocardiogram showed pericardial effusion and a right atrioventricular mass. The resected tumour was confirmed to be diffuse large b-cell lymphoma on histopathology. Unfortunately, the patient died few hours after surgery. Case 2: 30-year-old HIV infected pregnant female presented with features of cardiac tamponade. The transthoracic echocardiogram showed pericardial effusion with right atrial mass. The resected tumour was confirmed to be Burkitt's lymphoma on histopathology. She was successfully treated with chemotherapy.

CLINICAL DISCUSSION

Cardiac lymphomas are rare with most cases diagnosed on autopsy. However, advances in diagnostic methods has increased antemortem diagnosis with subsequent optimal management. Majority of the cases are of B-cell lineage, although T-cell origin has been reported.

CONCLUSION

A high index of suspicion of cardiac lymphoma should be maintained in the right clinical setting in order to receive adequate attention and management.

A case report of a primary cardiac lymphoma causing superior vena cava obstruction: the value of multimodality imaging in the clinical workup

BACKGROUND

This is a case report of a primary cardiac lymphoma with an unusual clinical presentation. We hereby illustrate the characteristic features of cardiac lymphomas by multimodality imaging and particularly cardiac magnetic resonance (CMR) that can help reach a timely diagnosis non-invasively and guide treatment decisions.

CASE SUMMARY

A 58-year-old woman, without significant past medical history, presented with a 3-week history of shortness of breath associated with facial and neck swelling. Transthoracic echocardiogram confirmed the presence of a cardiac mass in the right atrium. Cardiac magnetic resonance helped to characterize the mass, assess its haemodynamic significance and relation to cardiac structures, and reach a non-invasive diagnosis that was crucial for guiding treatment decisions and interventions.

DISCUSSION

Cardiac masses have distinct imaging features that can help differentiate malignant from benign cardiac tumours. More specifically, primary cardiac lymphomas can be relatively easy diagnosed by CMR in most cases thanks to their characteristic imaging appearance.