Primary Cardiac Lymphoma: Importance of Tissue Diagnosis

Rituximab-based regimens for primary cardiac lymphoma: A systematic review of outcomes, challenges and future directions

BACKGROUND

Primary cardiac lymphoma (PCL) is a rare subset of cardiac tumors, often diagnosed late due to nonspecific symptoms. It predominantly affects immunocompromised individuals, primarily in the pericardium and right heart. Late diagnosis mimics common cardiac ailments, leading to poor prognosis.

AIM

To systematically review the efficacy of rituximab in treating PCL either alone or in various chemotherapeutic regimens. Secondary objectives include evaluating morphological subtypes, assessing treatment regimens, and analyzing outcomes focusing on remission and adverse events.

METHODS

Following PRISMA guidelines, a comprehensive literature search was conducted across multiple databases, including PubMed, Hinari, Web of Science, and Scopus. English-language studies reporting the use of rituximab in treating PCL in humans were included. Study selection involved initial screening of titles and abstracts followed by full-text examination and data extraction.

RESULTS

Thirty-three case reports involving 36 patients were included in this systematic review. Diffuse large B-cell lymphoma was the predominant morphological subtype observed. The rituximab, cyclophosphamide, doxorubicin, oncovin, and prednisolone regimen emerged as the most commonly employed treatment strategy, indicating widespread acceptance and efficacy in PCL management. Combination therapies, including surgical intervention, showed promise in achieving complete remission, while some studies reported mortality despite aggressive treatment approaches.

CONCLUSION

Rituximab, particularly in combination with chemotherapy regimens, represents a significant advancement in PCL management, offering hope for improved patient outcomes. However, challenges such as variable treatment responses and adverse events underscore the complexity of managing PCL. Further research is warranted to refine therapeutic strategies and enhance diagnostic approaches for this rare cardiac malignancy.

Follicular lymphoma with cardiac involvement in a 90-year-old patient: A case report

BACKGROUND

The incidence of cardiac lymphoma is low, and it mainly occurs secondary to non-Hodgkin’s lymphoma, particularly diffuse large B-cell lymphoma. Here, we report a case of follicular lymphoma with cardiac involvement and severe heart failure as the sole clinical manifestation.

CASE SUMMARY

A 90-year-old male patient was first admitted to our hospital due to an accidentally discovered painless mass in the right lower abdomen. A biopsy of the mass revealed a follicular lymphoma. Positron emission tomography-computed tomography confirmed mild pericardial effusion, and echocardiography showed no structural abnormalities with normal ejection fraction at the time of diagnosis. The patient refused our recommendation of chemotherapy and was re-admitted 4 mo later due to heart failure. A series of subsequent echocardiographic examinations showed thickening of the left ventricular walls and increasing pericardial effusion over the following 2 mo. His heart failure exacerbated despite all symptomatic and supportive treatments. He passed away after an episode of aspiration pneumonia.

CONCLUSION

The diagnosis of cardiac lymphoma is difficult as its clinical manifestations are nonspecific, and prognosis is poor.

The role of cardiac CT and MRI in the diagnosis and management of primary cardiac lymphoma: A comprehensive review

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.

Primary Cardiac Lymphoma in a Cat

A 5-year-old neutered male domestic shorthaired cat was presented with neurological signs. A primary cardiac lymphoma (PCL) with metastasis to the meninges of the brain was diagnosed histologically. Immunohistochemistry confirmed a B-cell lymphoma. Reports of PCL in cats are scarce. The current case describes a primary cardiac B-cell lymphoma in a cat confirmed by histopathology and immunohistochemistry, and underscores the significance of histopathology for definitive diagnosis.