1
|
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.
Collapse
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
| |
Collapse
|
2
|
Prenek L, Csupor K, Beszterczán P, Boros K, Kardos E, Vorobcsuk A, Egyed M, Kellner Á, Rajnics P, Varga C. Diagnostic pitfalls: intramyocardial lymphoma metastasis mimics acute coronary syndrome in a diffuse large B cell lymphoma patient-case report. Int J Emerg Med 2021; 14:29. [PMID: 33962562 PMCID: PMC8103629 DOI: 10.1186/s12245-021-00352-x] [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: 10/15/2020] [Accepted: 04/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background Cardiac tumors are very uncommon compared to other cardiac diseases. Their clinical symptoms can vary from absent to non-specific. The most common symptoms are arrhythmias, blood flow obstruction due to valvular dysfunction, shortness of breath, systemic embolization, and accumulation of pericardial fluid. Hereby, we describe a very rare case of a diffuse large B cell lymphoma patient who presented with the symptoms and signs of acute coronary syndrome (ACS) but the patient’s complaints were caused by his intramyocardial lymphoma metastasis. Case presentation Forty-eight-year-old diffuse large B cell lymphoma patient was admitted to our emergency department with chest pain, effort dyspnea, and fever. The patient had normal blood pressure, blood oxygen saturation, sinus tachycardia, fever, crackles over the left lower lobe, novum incomplete right bundle branch block with Q waves and minor ST alterations, elevated C-reactive protein, high-sensitivity troponin-T, and d-dimer levels. Chest X-ray revealed consolidation on the left side and enlarged heart. Bed side transthoracic echocardiography showed inferior akinesis with pericardial fluid. Coronary angiography showed no occlusion or significant stenosis. Chest computed tomography demonstrated the progression of his lymphoma in the myocardium. He was admitted to the Department of Hematology for immediate chemotherapy and he reached complete metabolic remission, followed by allogeneic hematopoietic stem cell transplantation. Unfortunately, about 9 months later, he developed bone marrow deficiency consequently severe sepsis, septic shock, and multiple organ failure what he did not survive. Conclusions Our case demonstrates a very rare manifestation of a heart metastasis. ACS is an unusual symptom of cardiac tumors. But our patient’s intramyocardial lymphoma in the right atrium and ventricle externally compressed the right coronary artery and damaged the heart tissue, causing the patient’s symptoms which imitated ACS. Fortunately, the quick diagnostics and immediate aggressive chemotherapy provided the patient’s remission and suitability to further treatment.
Collapse
Affiliation(s)
- Lilla Prenek
- Department of Emergency Medicine, Teaching Hospital Mór Kaposi, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary
| | - Klára Csupor
- Department of Emergency Medicine, Teaching Hospital Mór Kaposi, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary
| | - Péter Beszterczán
- Department of Emergency Medicine, Teaching Hospital Mór Kaposi, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary
| | - Krisztina Boros
- Department of Emergency Medicine, Teaching Hospital Mór Kaposi, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary.,Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, Semmelweis Street 6, Szeged, 6725, Hungary
| | - Erika Kardos
- Department of Radiology, Teaching Hospital Mór Kaposi, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary
| | - András Vorobcsuk
- Department of Cardiology, Teaching Hospital Mór Kaposi, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary
| | - Miklós Egyed
- Department of Hematology, Teaching Hospital Mór Kaposi, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary
| | - Ádám Kellner
- Department of Hematology, Teaching Hospital Mór Kaposi, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary
| | - Péter Rajnics
- Department of Hematology, Teaching Hospital Mór Kaposi, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary. .,Faculty of Health Sciences, Doctoral School, University of Pécs, Vörösmarty Mihály Street 4, Pécs, 7621, Hungary.
| | - Csaba Varga
- Department of Emergency Medicine, Teaching Hospital Mór Kaposi, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary.,Institute of Emergency Care and Pedagogy of Health, Faculty of Health Sciences, University of Pécs, Vörösmarty Mihály Street 4, Pécs, 7621, Hungary
| |
Collapse
|
3
|
Li X, Chen Y, Liu J, Xu L, Li Y, Liu D, Sun Z, Wen Z. Cardiac magnetic resonance imaging of primary cardiac tumors. Quant Imaging Med Surg 2020; 10:294-313. [PMID: 31956550 DOI: 10.21037/qims.2019.11.13] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiac magnetic resonance (CMR) offers superior advantages in cardiac imaging due to supplying a greater field of view, excellent soft-tissue imaging, and multiplanar imaging capabilities. CMR imaging can evaluate the characteristics of cardiac tumors by visualizing the relationship between the tumor and surrounding tissues, and plays a vital role in assisting the formulation of the surgical plan, the assessment of tumor progression, and the monitoring of postoperative tumor recurrence and metastasis. In this review, we present the clinical manifestations and imaging features of different cardiac tumors. The superior performance of CMR in preoperative diagnosis, surgical treatment, and postoperative follow-up of patients with heart tumors are also highlighted.
Collapse
Affiliation(s)
- Xiaodan Li
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yan Chen
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jiayi Liu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yu Li
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Dongting Liu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Australia
| | - Zhaoying Wen
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| |
Collapse
|
4
|
Al-Mehisen R, Al-Mohaissen M, Yousef H. Cardiac involvement in disseminated diffuse large B-cell lymphoma, successful management with chemotherapy dose reduction guided by cardiac imaging: A case report and review of literature. World J Clin Cases 2019; 7:191-202. [PMID: 30705895 PMCID: PMC6354095 DOI: 10.12998/wjcc.v7.i2.191] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/26/2018] [Accepted: 01/04/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Secondary cardiac involvement by lymphoma has received limited attention in the medical literature, despite its grave prognosis. Although chemotherapy improves patients’ survival, a subgroup of treated patients dies suddenly due to myocardial rupture following chemotherapy initiation. Reducing the initial chemotherapy dose with dose escalation to standard doses may be effective in minimizing this risk but the data are limited. We report on the successful management of a patient with disseminated diffuse large B-cell lymphoma (DLBCL) involving the heart using such approach.
CASE SUMMARY An 18-year-old male presented to our hospital with six months history of progressive dyspnea, orthopnea and cough. On physical examination, the patient was found to have a plethoric and mildly edematous face, fixed elevation of the right internal jugular vein, suggestive of superior vena cava obstruction, and a pelvic mass. Investigations during admission including a thoracoabdominal computed tomography (CT) scan with CT guided biopsy of the pelvic mass, echocardiography and cardiac magnetic resonance imaging led to the diagnosis of disseminated DLBCL with cardiac involvement. The patients were successfully treated with chemotherapy dose reduction followed by dose escalation to standard doses, under the guidance of cardiac imaging. The patient completed chemotherapy and underwent a successful bone marrow transplant. He is currently in remission and has a normal left ventricular function.
CONCLUSION Imaging-guided chemotherapy dosing may minimize the risk of myocardial rupture in cardiac lymphoma. Data are limited. Management should be individualized.
Collapse
Affiliation(s)
- Rabah Al-Mehisen
- Department of Cardiology, Security Forces Hospital, Riyadh 11481, Saudi Arabia
| | - Maha Al-Mohaissen
- Department of Clinical Sciences (Cardiology), Princess Nourah Bint Abdulrahman University Research Chair in Cardiovascular Disease in Women, Princess Nourah Bint Abdulrahman University, Riyadh 11511, Saudi Arabia
| | - Hisham Yousef
- Department of Internal Medicine, Division of Hematology/Oncology, Security Forces Hospital, Riyadh 11481, Saudi Arabia
| |
Collapse
|
5
|
Vadi SK, Parihar AS, Mittal BR, Kumar R, Singh H, Malhotra P. F-18 Fluorodeoxyglucose Positron-Emission Tomography-Computed Tomography in a Case of Extensive Multi-Organal Extranodal Lymphoma with Cardiac Involvement Mimicking Apical Hypertrophic Obstructive Cardiomyopathy: Staging and Response Evaluation. Indian J Nucl Med 2018; 33:370-373. [PMID: 30386069 PMCID: PMC6194772 DOI: 10.4103/ijnm.ijnm_67_18] [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] [Indexed: 11/04/2022] Open
Abstract
18F fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) is a standard imaging tool in staging as well as response evaluation for lymphoma. Here, we present a young male with extensive extranodal lymphoma with cardiac involvement which presented as diffuse myocardial lesion mimicking hypertrophic obstructive cardiomyopathy. 18F-FDG PET/CT helped in the staging by revealing multiple systemic involvements. Interim PET after three cycles of chemotherapy showed a complete metabolic response to therapy in all the extranodal sites including the cardiac involvement, thus retrospectively confirming the lymphomatous involvement. Previous literature also conforms to the superior role of 18F-FDG PET/CT in the clinical management of extensive extranodal lymphoma.
Collapse
Affiliation(s)
- Shelvin Kumar Vadi
- Department of Nuclear Medicine and PET/CT, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashwin Singh Parihar
- Department of Nuclear Medicine and PET/CT, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine and PET/CT, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajender Kumar
- Department of Nuclear Medicine and PET/CT, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harmandeep Singh
- Department of Nuclear Medicine and PET/CT, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Hemato-Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
6
|
Cheng H, Feldman T, Butt Y, Chow KF, Yang XY, Bhattacharyya PK, de Vinck DC. T-cell prolymphocytic leukemia with extensive cardiovascular infiltrate leading to multiple myocardial infarctions and cardiac death. Tex Heart Inst J 2014; 41:626-30. [PMID: 25593528 DOI: 10.14503/thij-13-3581] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Lymphocytic neoplasm involving the heart is not common and usually presents with pericardial effusion or focal myocardial infiltration. Myocardial infarctions due to leukemic infiltration of the coronary arteries are rarely reported. We present the case of a 52-year-old Guatemalan man with a one-year history of untreated T-cell prolymphocytic leukemia. He was admitted to our hospital for chemotherapy and evaluation of a pulmonary cavitary lesion by wedge resection. During sedation, the patient experienced acute respiratory failure and hypovolemic shock, from which he could not be resuscitated. Autopsy revealed that leukemic cells extensively infiltrated the aorta, myocardium, and coronary arteries. The lumina of the 3 major coronary artery branches showed 70% to 95% stenosis, with multifocal remote myocardial infarctions. Tumor cells were also detected in the lungs and other organs. The acute cardiorespiratory insufficiency secondary to leukemia-particularly the extensive infiltration of the coronary arteries and myocardium, and the multiple myocardial infarctions-eventually resulted in cardiac death.
Collapse
|