1
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Khasawneh A, McGuinness G, Ward N. Initial diagnosis of extranodal NK/T-cell lymphoma in pericardial fluid with concomitant hemophagocytic lymphohistiocytosis (HLH). J Hematop 2024; 17:27-36. [PMID: 38376724 DOI: 10.1007/s12308-023-00572-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/16/2023] [Indexed: 02/21/2024] Open
Abstract
Extranasal natural killer/T-cell lymphoma arising in the heart is rare and typically presents with non-specific clinical symptoms, necessitating a biopsy for a definitive diagnosis. We report an unusual case of a 48-year-old male who initially presented with chest pain and shortness of breath. Subsequent diagnosis via pericardial fluid analysis, including flow cytometry and immunohistochemical stains, revealed extranasal NK/T-cell lymphoma without sinonasal involvement. The analysis identified neoplastic lymphoid cells expressing CD2, cytoplasmic CD3, Epstein-Barr virus, and CD56 and exhibiting increased Ki-67 staining. Additionally, the patient developed hemophagocytosis lymphocytosis secondary to NK/T cell lymphoma. Treatment included an interleukin-1 receptor antagonist (anakinra), dexamethasone, rituximab, and etoposide. Unfortunately, the patient's condition rapidly deteriorated, leading to multiorgan failure and eventual demise. Given the rarity of this lymphoma, early diagnosis based on a high suspicion level provides the best chance for improved overall survival.
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Affiliation(s)
- Amani Khasawneh
- Department of Pathology, New York University Langone Medical Center, 240 East 38Th Street, 22Nd Floor, New York, NY, USA
| | - Georgeann McGuinness
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Nicholas Ward
- Department of Pathology, New York University Langone Medical Center, 240 East 38Th Street, 22Nd Floor, New York, NY, USA.
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2
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Ghantous E, Hochstadt A, Aviram G, Perry C, Ingbir M, Havakuk O, Banai S, Topilsky Y, Laufer-Perl M. Primary Cardiac Lymphoma Patients Presenting With Heart Failure. CASE (Phila) 2023; 7:449-455. [PMID: 38028382 PMCID: PMC10679538 DOI: 10.1016/j.case.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
•DLBCL is the most common type of lymphoma with cardiac involvement. •Obtaining tissue for diagnosis may be challenging in PCLs. •A safe diagnostic procedure may diagnose DLBCL patients with cardiac masses. •R-CHOP chemotherapy protocol is the standard treatment for PCL.
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Affiliation(s)
- Eihab Ghantous
- Division of Cardiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Hochstadt
- Division of Cardiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galit Aviram
- Division of Radiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chava Perry
- Division of Hematology, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Ingbir
- Department of Internal Medicine J, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Havakuk
- Division of Cardiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Banai
- Division of Cardiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yan Topilsky
- Division of Cardiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Laufer-Perl
- Division of Cardiology, Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Farhoud N, Farhoud H, Deutsch JM. Primary Cardiac Lymphoma in a Young and Immunocompetent Patient Diagnosed by Percutaneous Transvenous Biopsy. Am J Cardiol 2023; 201:139-141. [PMID: 37385165 DOI: 10.1016/j.amjcard.2023.05.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/21/2023] [Accepted: 05/31/2023] [Indexed: 07/01/2023]
Abstract
Primary cardiac lymphoma is a rare cardiac neoplasm that is typically found in older, immunocompromised patients. In this case, we report an immunocompetent, 46-year-old female that presented with shortness of breath and chest discomfort. Diagnosis of primary cardiac lymphoma was confirmed by way of percutaneous transvenous biopsy under transesophageal echocardiography and cardiac fluoroscopy guidance.
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Affiliation(s)
- Noor Farhoud
- University of Kansas School of Medicine, Wichita, Kansas.
| | - Hassan Farhoud
- University of Kansas School of Medicine, Wichita, Kansas
| | - Jeremy M Deutsch
- Internal Medicine Department, University of Kansas School of Medicine, Wichita, Kansas
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4
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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5
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Li J, Liu Q, Peng Q, Dong S. Diagnosis of rapidly progressed primary cardiac lymphoma in liver transplant recipient: A case report. Front Oncol 2022; 12:1014371. [PMID: 36212392 PMCID: PMC9544802 DOI: 10.3389/fonc.2022.1014371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/09/2022] [Indexed: 12/02/2022] Open
Abstract
Primary cardiac lymphomas (PCLs) are extremely rare and affect the heart. Patients with PCLs usually have delayed diagnosis and treatment. As a consequence, their prognosis is quite unfavorable, and their median survival is approximately 7 months. Herein, we report a 64-year-old man who underwent liver transplantation, presented with chest pain and exertional dyspnea, developed a huge cardiac mass within 2 months and passed away on day 3 of hospitalization. Histological examination revealed diffuse large B-cell lymphoma (DLBCL), which is a rare cardiac tumor with a poor prognosis. In this case, DLBCL was only detected postmortem. The extension of the mass and its relationship with the heart were explored with non-invasive cardiac imaging. Despite the rarity of DLBCL, it should be considered in the differential diagnosis of cardiac tumors.
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Affiliation(s)
- Jianghua Li
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People’s Hospital, Shenzhen, China
- *Correspondence: Jianghua Li, ; Shaohong Dong,
| | - Qiyun Liu
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People’s Hospital, Shenzhen, China
| | - Quanzhou Peng
- Department of Pathology, Shenzhen People’s Hospital, Shenzhen, China
| | - Shaohong Dong
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People’s Hospital, Shenzhen, China
- *Correspondence: Jianghua Li, ; Shaohong Dong,
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6
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Akimana G, Mesmoudi B, Benasser M, Errihani H, Oukerraj L. Secondary Cardiac Involvement From Diffuse Large B-cell Lymphoma: A Case Report. Cureus 2022; 14:e27664. [PMID: 36072208 PMCID: PMC9440400 DOI: 10.7759/cureus.27664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 12/03/2022] Open
Abstract
The cardiac localization of metastases is a rare condition, most often found on autopsy. Lymphoma is among the primary cancers often involved, as was the case for our patient in whom cardiac involvements were discovered during the extension assessment by imaging. Clinically asymptomatic in the majority of cases, we mainly find general symptoms related to the primary disease. Because histological diagnosis is rarely possible by biopsy, confirmation is made by imaging in the context of disseminated disease. The treatment of cardiac involvements of lymphomatous origin is often medical with a poor prognosis.
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7
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Gao F, Koh S, Taveras-Alam S, Khalid U. A Right Atrial Mass with Fever and Cutaneous Nodules. Methodist Debakey Cardiovasc J 2022; 18:48-53. [PMID: 35891700 PMCID: PMC9284981 DOI: 10.14797/mdcvj.1126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/13/2022] [Indexed: 11/08/2022] Open
Abstract
Primary cardiac tumors, although exceedingly rare, should be considered in the differential diagnosis during workup of any cardiac mass. Extranodal cardiac lymphomas have a natural aggressive course due to delayed diagnosis. We present a 71-year-old male with a dual-chamber pacemaker who presented with fevers and new cutaneous nodules. He was found to have a right atrial primary anaplastic large-cell lymphoma and had a complete metabolic response after chemotherapy. Our case highlights the importance of a multimodality approach in the diagnosis of cardiac tumors and during follow-up after treatment.
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Affiliation(s)
- Feng Gao
- Baylor College of Medicine, Houston, Texas, US
| | | | | | - Umair Khalid
- Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, US
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Bernstein HM, English C, Young RB, Venugopal S. A 70-Year-Old Man With Relapsed CNS Lymphoma Has Incidental Finding of Right Atrial Mass. Chest 2022; 162:e43-e48. [DOI: 10.1016/j.chest.2022.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/29/2021] [Accepted: 01/17/2022] [Indexed: 12/01/2022] Open
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9
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Affiliation(s)
- Mason Sanders
- Division of Cardiology, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina
- Address reprint requests and correspondence: Dr Mason Sanders, Department of Medicine, University of North Carolina Medical Center, 160 Dental Circle, CB 7075, Chapel Hill, NC 27599.
| | - Casey Gazda
- Division of Cardiology, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina
| | | | - J. Larry Klein
- Division of Cardiology, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Reza Khalfan
- Alabama College of Osteopathic Medicine, Dothan, Alabama
| | - Anil K. Gehi
- Division of Cardiology, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina
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10
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Gabali A. Serous fluids and hematolymphoid disorders. Cytojournal 2022; 19:17. [PMID: 35510123 PMCID: PMC9063582 DOI: 10.25259/cmas_02_12_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/02/2021] [Indexed: 12/05/2022] Open
Abstract
Diagnosing hematolymphoid neoplasm by evaluating fine-needle aspiration (FNA) cytology sample is controversial and requires experience and clinical skills. This concept becomes more challenging when evaluating hematolymphoid neoplasm in body fluid. Differentiating between low-grade lymphoma and reactive lymphocytes is often difficult by morphology alone as reactive lymphoid cells may acquire activation morphology from being exposed to different cytokines within the body fluid. However, in most cases there are specific features that may aid in differentiating small reactive from non-reactive lymphocytes including the round shape of the nucleus, the absence of visible nucleoli and the presence of fine clumped chromatin. In large cell lymphoma and leukemia cells involvement of body fluid this concept becomes less challenging. Large cell lymphoma and leukemia cells tend to have large size nuclei, less mature chromatin, and visible nucleoli with and without cytoplasmic vacuoles. However, to reach accurate diagnosis and subclassification, the utilizing of flow cytometry, to confirm monoclonality, and other ancillary studies such immunocytochemistry, cytogenetics and molecular studies is needed. This review article will be incorporated finally as one of the chapters in CMAS (CytoJournal Monograph/Atlas Series) #2. It is modified slightly from the chapter by the initial authors in the first edition of Diagnostic Cytopathology of Serous Fluids.
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Affiliation(s)
- Ali Gabali
- Director of Hematopathology and Hematopathology Fellowship, Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center, Detroit, Michigan, United States
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11
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Al Mawed M, Brockmeier J, Haertel D, Ellermeier M, Hartmann F, Gielen S. From inoperable to back to life: a case report of successfully treated obstructive right ventricular primary cardiac lymphoma. Eur Heart J Case Rep 2022; 6:ytac051. [PMID: 35198851 PMCID: PMC8859631 DOI: 10.1093/ehjcr/ytac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/27/2021] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Cardiac masses include various tumourous and non-tumourous lesions. Primary cardiac tumours are very rare and most commonly benign. Primary cardiac lymphomas (PCL) account for 1-2% of malignant primary cardiac tumours. Only 197 cases of PCL have been reported between 1949 and 2009. CASE SUMMARY We report a case of a 73-year-old patient who presented with atrial flutter. The diagnosis was a tumourous cardiac mass in the right atrium with signs of the infiltration of the tricuspid valve insertion and pericardium. There were no signs of extracardiac disease at the initial presentation. The patient was deemed to be inoperable by cardiac surgeons. Rapid tumour progression caused atrioventricular-block type Mobitz 2 with concomitant obstruction of the tricuspid valve and axillary lymph node metastasizing. Excision of the axillary lymph node revealed a diffuse large B-cell non-Hodgkin lymphoma. An epicardial right ventricle single lead pacemaker was sited, and chemotherapy was administered, resulting in complete remission. DISCUSSION Cardiac masses are rare and challenging cases. Although current imaging procedures deliver extensive information, histological examination is still required in many cases. We encountered a tumourous mass with deep infiltration. After the patient was deemed inoperable, later lymph node invasion allowed histological examination, revealing PCL. Primary cardiac lymphomas are life-threatening tumours with rapid and aggressive growth. Treatment is based on chemotherapy consisting of anthracycline-containing regimens. This case report highlights the curative potential of chemotherapy, as we report a rapid regression of the tumour as well as the disappearance of arrhythmias and conduction disorders after treatment.
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Affiliation(s)
- Mohammad Al Mawed
- Department of Cardiology, Angiology and internal intensive care, Klinikum Lippe GmbH, Röntgenstraße 18, 32756 Detmold, NRW, Germany
| | - Johannes Brockmeier
- Department of Cardiology, Angiology and internal intensive care, Klinikum Lippe GmbH, Röntgenstraße 18, 32756 Detmold, NRW, Germany
| | - Dirk Haertel
- Department of Cardiology, Angiology and internal intensive care, Klinikum Lippe GmbH, Röntgenstraße 18, 32756 Detmold, NRW, Germany
| | - Marc Ellermeier
- Institute of Radiology, Klinikum Lippe GmbH, Röngenstraße 18, 32756 Detmold, NRW, Germany
| | - Frank Hartmann
- Department of haematology and oncology, Klinikum Lippe GmbH, Rintelner Str. 85, 32657 Lemgo, NRW, Germany
| | - Stephan Gielen
- Department of Cardiology, Angiology and internal intensive care, Klinikum Lippe GmbH, Röntgenstraße 18, 32756 Detmold, NRW, Germany
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12
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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13
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Abstract
Primary cardiac lymphoma is a rare entity of extranodal lymphoma and is observed with increasing frequency in immunocompromised hosts. However, a considerable proportion of cardiac lymphomas still occur in immunocompetent patients. We report the case of a 55-year-old immunocompetent Japanese man with a large amount of pericardial fluid and the presentation of heart failure secondary to primary cardiac B cell lymphoma, which was diagnosed by cytological examination of pericardial fluid and imaging. The right atrium, right ventricle and pericardium were affected by the tumour, which encased the mid/distal portion of the right coronary artery (RCA). Pretreatment optical coherence tomography of the RCA demonstrated no tumour extension into the vascular structure but a focal mural thrombus. We initiated chemotherapy (steroid therapy then COP at half dose/R-CHOP/R-CHASE) [COP (C: Cyclophosphamide, O: Oncovin, P: Prednisolone) R-CHOP (R: Rituximab, C: Cyclophosphamide, H: Doxorubicin Hydrochloride, O: Oncovin, P: Prednisolone) R-CHASE (R: Rituximab, C: Cyclophosphamide, HA: high dose Cytarabine, S: Steroid, E: Etoposide)]with administration of low-dose aspirin to prevent possible ischaemic events. The patient had a good clinical course without adverse events except for transient pericarditis.
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Affiliation(s)
- Masashi Miyawaki
- Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Rie Aoyama
- Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Joji Ishikawa
- Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Kazumasa Harada
- Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, Japan
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Ninh TP, Duc NM, Trung NN, Duc LA, Ngoc DV, My TT, Sang NV, Thong PM. Multifocal precursor B-cell lymphoblastic lymphoma in an infant with cardiac involvement: A case report. Radiol Case Rep 2021; 16:2054. [PMID: 34158892 DOI: 10.1016/j.radcr.2021.04.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 01/21/2023] Open
Abstract
Lymphoma with cardiac involvement is a high-risk lesion, especially in children. We report a rare clinical case of multifocal precursor B-cell lymphoblastic lymphoma in a child with cardiac involvement. A 4-year-old boy presented to the Vietnam National Children's Hospital with a vague headache, but magnetic resonance imaging of the head was normal. After 1 week, the patient showed symptoms of chest pain, fatigue, dyspnea, and abdominal pain. On transthoracic echocardiography and multislice computed tomography of the thorax, a mass was detected in the right atrial wall. Abdominal ultrasound showed a small bowel intussusception, multiple nodules in the intestinal wall, and mesenteric lymph nodes. Histopathology of the bowel confirmed the diagnosis of multifocal precursor B-cell lymphoblastic lymphoma. The patient responded to 3 cycles of chemotherapy for lymphoma. Therefore, combining multiple imaging methods allowed for early diagnosis and improved treatment.
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17
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Fukui T, Ogasawara N, Hasegawa S. Unique autopsy case of primary cardiac lymphoma. BMJ Case Rep 2021; 14:e242174. [PMID: 33782075 PMCID: PMC8009205 DOI: 10.1136/bcr-2021-242174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tomoki Fukui
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Nobuyuki Ogasawara
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Shinji Hasegawa
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
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18
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Abstract
Cardiac neoplasms are a diagnostic challenge on many levels. They are rare, their clinical presentation may mimic other much more common cardiac diseases, and they are at an uncommon intersection of oncologic and cardiac imaging. The pathology of primary cardiac neoplasms explains their varied imaging features, for example, calcification in primary cardiac osteosarcomas and T2 hyperintensity in myxomas. Integrating the imaging and pathologic features of cardiac tumors furthers our understanding of the spectrum of appearances of these neoplasms and improves the clinical imager's ability to confidently make a diagnosis.
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Affiliation(s)
- John P Lichtenberger
- The George Washington University Medical Faculty Associates, 900 23rd Street Northwest, Suite G 2092, Washington, DC 20037, USA.
| | - Brett W Carter
- Department of Thoracic Imaging, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
| | - Michael A Pavio
- Department of Radiology, Walter Reed National Military Medical Center, 4494 North Palmer Road, Bethesda, MD 20889, USA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Panareo S, Urso L, Santi I, Rigolin GM, Cuneo A, Cittanti C, Bartolomei M. Right Atrium Mass Assessed with 18F-FDG PET/CT Scan Turns Out to Be an Uncommon Relapse of Testicular Diffuse Large B-cell Lymphoma: A Case Report. Diagnostics (Basel) 2020; 10:E987. [PMID: 33238362 DOI: 10.3390/diagnostics10110987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 11/17/2022] Open
Abstract
We report the case of a 71-year-old man affected by testicular large B-cell lymphoma (DLBCL), treated with right orchiectomy and first-line chemotherapy (R-CHOP, 8 cycles). A complete remission was obtained after therapy. Twenty-two months after the primary diagnosis the patient suddenly presented dyspnoea and superior vena cava syndrome; thus, he underwent a CT scan that revealed a large mass in the right atrium, expanding to the superior vena cava. A differential diagnosis between a neoplastic mass and a clot was proposed. The subsequent MR did not clarify the nature of the mass; therefore, the patient underwent an 18F-FDG PET/CT scan (PET/CT), after a specific preparation to reduce fluoro-deoxyglucose (FDG) myocardial uptake. PET/CT revealed an intense FDG uptake involving the whole mass (SUVmax 9.4), suggestive for neoplasm and confirmed by the subsequent endocardiac biopsy. The patient was treated with 8 cycles of R-COMP, obtaining a complete remission, as indicated by the PET/CT performed after the seventh cycle of therapy. The case that we are reporting highlights that DLBCL can have an uncommon relapse presentation in the atrium. PET/CT, compared to conventional imaging, can be a valuable tool to detect early and better characterize cardiac lesions in order to improve the poor prognosis of these conditions.
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Yin K, Brydges H, Lawrence KW, Wei Y, Karlson KJ, McAneny DB, Edwards NM, Reardon MJ, Dobrilovic N. Primary cardiac lymphoma. J Thorac Cardiovasc Surg 2020:S0022-5223(20)32706-9. [PMID: 33158567 DOI: 10.1016/j.jtcvs.2020.09.102] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/12/2020] [Accepted: 09/18/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aimed to understand the population-level treatment modalities and to evaluate the survival benefits of surgical resection in primary cardiac lymphoma. METHODS We queried the Surveillance, Epidemiology, and End Results Program database, which covers 35% of the US population. Patients with a histologic diagnosis of primary cardiac lymphoma from 1973 to 2015 were included. Multivariable accelerated failure time regression was performed to evaluate the associations between clinical factors and overall survival. RESULTS A total of 184 patients were identified. The median age was 68 years, 80% were White, and 46% were women. Diffuse large B-cell lymphoma (80%) was the most common histology, and the majority (65%) was low-stage lymphoma (Ann Arbor stage I or II). Median survival was 2.2 years. Seventy-three percent of patients received chemotherapy. Only 10% of patients received local resection or debulking. Multivariable analysis demonstrated that local resection or debulking was not independently associated with overall survival (adjusted hazard ratio, 0.67; 95% confidence interval, 0.30-1.48; P = .32). Instead, chemotherapy (adjusted hazard ratio, 0.4; 95% confidence interval, 0.23-0.69; P < .001) was independently associated with improved survival, whereas increasing age (adjusted hazard ratio of 5-year increment, 1.13; 95% confidence interval, 1.04-1.22; P <.001) and advanced stage (adjusted hazard ratio, 2.18; 95% confidence interval, 1.33-3.56; P < .001) were independently associated with worse survival. CONCLUSIONS Surgical resection was not independently associated with survival in patients with primary cardiac lymphoma. Chemotherapy was the predominant treatment option and associated with improved survival, whereas increasing age and advanced stage were independently associated with worse outcomes.
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Mohri T, Igawa O, Isogaya K, Hoshida K, Togashi I, Soejima K. Primary cardiac B-cell lymphoma involving sinus node, presenting as sick sinus syndrome. HeartRhythm Case Rep 2020; 6:694-696. [PMID: 33101934 PMCID: PMC7573383 DOI: 10.1016/j.hrcr.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Takato Mohri
- Department of Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Osamu Igawa
- Department of Cardiology, Nihon Medical University Hospital, Tokyo, Japan
| | - Kazunobu Isogaya
- Department of Pathology, Kyorin University Hospital, Tokyo, Japan
| | - Kyoko Hoshida
- Department of Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Ikuko Togashi
- Department of Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University Hospital, Tokyo, Japan
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Xiao M, Lin J, Xiao T, Lin Y, Ye Y. The incidence and survival outcomes of patients with primary cardiac lymphoma: A SEER-based analysis. Hematol Oncol 2020; 38:334-343. [PMID: 32311106 DOI: 10.1002/hon.2741] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/28/2020] [Accepted: 04/14/2020] [Indexed: 12/12/2022]
Abstract
This study aimed to evaluate the incidence and prognosis of primary cardiac lymphoma (PCL) by using the Surveillance, Epidemiology, and End Results Program (SEER) database. Patients diagnosed with PCL and the disease incidence in the SEER database from 1975 to 2016 were included. Overall survival (OS) and cause-specific survival (CSS) curves were calculated using the Kaplan-Meier method and compared by the log-rank test. Univariate and multivariable Cox proportional hazard regression analyses were used to identify associations with outcome measures. The incidence of PCL was 0.011/100 000, and a predominance of elderly and male patients was observed. A total of 144 patients were enrolled. The median age of onset was 68 (9-96) years, including 80 (55.6%) males and 64 (44.4%) females. Multivariate analysis revealed that age and chemotherapy were independent prognostic factors for OS (both P < .05). Ann Arbor stage and chemotherapy were independent prognostic factors for CSS (both P < .05). In terms of treatment modality, chemotherapy combined with surgery was an independent protective factor for OS and CSS (both P < .05). For patients with primary cardiac diffuse large B-cell lymphoma (cardiac DLBCL), multivariate analysis also showed that age, Ann Arbor stage, and chemotherapy were all independent prognostic factors for OS and CSS (all P < .05). Chemotherapy combined with surgery was associated with a significant benefit in terms of OS and CSS (both P < .05). Our study confirmed that older age and advanced Ann Arbor stage were independent risk factors for PCL, and treatment with chemotherapy or cooperation with surgery resulted in better long-term survival.
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Affiliation(s)
- Min Xiao
- Department of Intensive Care Unit, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Junpeng Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Tingting Xiao
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yan Lin
- Department of Intensive Care Unit, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Yong Ye
- Department of Intensive Care Unit, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
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Rosas D, Yepes I, Tschanz J, Wariboko M, Sandoval-Sus JD. Epstein-Barr Virus: From Kissing Disease to Broken Heart. Cureus 2020; 12:e7704. [PMID: 32431983 PMCID: PMC7233509 DOI: 10.7759/cureus.7704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We present a case of a 59 year old female patient that presented with exertional chest pain and palpitations. A workup revealed an EKG with signs of right ventricular hypertrophy, a high Pro-BNP and 3 sets of negative troponin levels. A CT scan of the chest was negative for pulmonary embolism (PE) but revealed a nodular thickening of the atrial septum with right atrial extension encasing the right coronary artery. A CT scan of the abdomen and pelvis with IV contrast revealed several nodular foci scattered in the subcutaneous fat of the abdominal wall bilaterally. An initial transthoracic echocardiogram (TTE) revealed thickening of the interatrial septum with a mass protruding from the interatrial septum into the left atrium and a secondary pedunculated mass protruding from the interatrial septum into the right atrium with significant obstruction within the right atrium. An ultrasound-guided biopsy of the soft tissue nodule in the right anterior abdominal wall and subcutaneous tissue showed the classical starry sky appearance pattern confirmed later to be a Burkitt lymphoma. The patient received chemotherapy and follow up CT of the abdomen and pelvis reported resolution of the soft tissue density involving the partially visualized portions of the heart. Although rare, cardiac lymphomas should be considered in the differential diagnosis of patients with identified cardiac masses. As the initial presentation is usually composed by non-specific symptoms, a detailed clinical history can identify certain constitutional symptoms and a thorough physical exam can lead to the suspicion of cardiac structural pathology prompting the need for the appropriate chest imaging. Further characterization may need TTE or TEE which are more sensitive and specific due to the tri-dimensional and temporal quality of the imaging. Appropriate biopsy with pathology and molecular studies are of utmost importance in making an accurate diagnosis in order to select the best management for this highly aggressive malignancy.
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Affiliation(s)
- Daniel Rosas
- Internal Medicine, Memorial Healthcare, Sunrise, USA
| | - Isaac Yepes
- Internal Medicine, Memorial Hospital West Healthcare System, Pembroke Pines, USA
| | - Jacqueline Tschanz
- Internal Medicine, Memorial Hospital West Healthcare System, Pembroke Pines, USA
| | - Minaba Wariboko
- Cardiology, Memorial Hospital West Healthcare System, Pembroke Pines, USA
| | - Jose D Sandoval-Sus
- Malignant Hematology & Cellular Therapy, Moffitt Cancer Center at Memorial Healthcare System, Pembroke Pines, USA
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Tang WQ, Zhou H, Xiao L, Li YJ. [An anaplastic cardiac large cell lymphoma: a cases report and literatures review]. Zhonghua Xue Ye Xue Za Zhi 2019; 40:858-61. [PMID: 31775488 DOI: 10.3760/cma.j.issn.0253-2727.2019.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Matsunaga K, Kobayashi T, Takahashi M, Gohra H. Huge Primary Cardiac Malignant Lymphoma in the Left Ventricle. Ann Thorac Surg 2020; 110:e115-e118. [PMID: 32035915 DOI: 10.1016/j.athoracsur.2019.12.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/14/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Abstract
A 67-year-old man presented at the hospital with worsening exertional dyspnea. Echocardiography showed a tumor in the left ventricle (approximately 35 × 48 mm) that protruded into the left atrium and left ventricular outflow tract during systole. These findings suggested a high risk of sudden death resulting from aortic valve obstruction or tumor embolism. Surgical resection was performed. During the operation, the tumor was resected as completely as possible, together with part of the myocardium where it arose. Histopathologic examination showed diffuse large B-cell lymphoma. The patient received systemic chemotherapy and is alive after 1 year.
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Affiliation(s)
- Kazumasa Matsunaga
- Department of Surgery, Saiseikai Yamaguchi General Hospital, Yamaguchi, Japan
| | - Toshiro Kobayashi
- Department of Surgery, Saiseikai Yamaguchi General Hospital, Yamaguchi, Japan.
| | - Masaya Takahashi
- Department of Surgery, Saiseikai Yamaguchi General Hospital, Yamaguchi, Japan
| | - Hidenori Gohra
- Department of Surgery, Saiseikai Yamaguchi General Hospital, Yamaguchi, Japan
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Abstract
Primary cardiac lymphoma (PCL) is a rare neoplasm involving the heart, pericardium or both. Patients with PCL have a median survival of approximately 7 months based on literature. We report a unique case of a 63-year-old woman presenting with worsening exertional dyspnoea and symptoms of superior vena cava obstruction. Investigations revealed a large right atrial (RA) tumour with obstructive features. In the past, PCL was frequently diagnosed at postmortem but with modern imaging and biopsy techniques, this allows early diagnosis and treatment of this rapidly fatal disease. Our patient had a trans-jugular venous biopsy of the RA mass under trans-oesophageal echocardiography guidance. This confirmed the diagnosis of PCL. She subsequently completed seven cycles of chemotherapy and is currently in remission 20 months after diagnosis.
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Affiliation(s)
- Alicia Xue Fen Chia
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Zitong Zhao
- Department of Pathology, Singapore General Hospital, Singapore
| | - See Lim Lim
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
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27
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Mandal AK, Selby FL, Deoraj S, Metaxa S, Missouris CG. Complete Regression of Primary Cardiac Lymphoma With Dose-Attenuated R-CVP Chemotherapeutic Regimen. JACC Case Rep 2019; 1:332-336. [PMID: 34316819 PMCID: PMC8289086 DOI: 10.1016/j.jaccas.2019.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/16/2019] [Accepted: 06/19/2019] [Indexed: 11/03/2022]
Abstract
An elderly man was found to have a large right atrioventricular mass and pericardial effusion. He was diagnosed and treated as having primary cardiac lymphoma. A dose-attenuated chemotherapy regimen of rituximab, cyclophosphamide, vincristine, and prednisolone, with a cytoreductive pre-phase, afforded complete regression of disease with resolution of the patient’s symptoms, and without deterioration in cardiac function or immunosuppression. The patient remains well 12 months after presentation. (Level of Difficulty: Advanced.)
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28
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Rajiah P, Fulton NL, Bolen M. Magnetic resonance imaging of the papillary muscles of the left ventricle: normal anatomy, variants, and abnormalities. Insights Imaging 2019; 10:83. [PMID: 31428880 PMCID: PMC6702502 DOI: 10.1186/s13244-019-0761-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/18/2019] [Indexed: 02/06/2023] Open
Abstract
Left ventricular papillary muscles are small myocardial structures that play an important role in the functioning of mitral valve and left ventricle. Typically, there are two groups of papillary muscles, namely the anterolateral and the posteromedial groups. Cardiovascular magnetic resonance (CMR) is a valuable imaging modality in the evaluation of papillary muscles, providing both morphological and functional information. There is a remarkably wide variation in the morphology of papillary muscles. These variations can be asymptomatic or associated with symptoms related to LV outflow tract obstruction, often associated with hypertrophic cardiomyopathy. Abnormalities of the papillary muscles range from congenital disorders to neoplasms. Parachute mitral valve is the most common congenital abnormality of papillary muscles, in which all the chordae insert into a single papillary muscle. Papillary muscles can become dysfunctional, most commonly due to ischemia. Papillary muscle rupture is a major complication of acute myocardial infarction that results in mitral regurgitation and associated with high mortality rates. The most common papillary neoplasm is metastasis, but primary benign and malignant neoplasms can also be seen. In this article, we discuss the role of CMR in the evaluation of papillary muscle anatomy, function, and abnormalities.
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Affiliation(s)
- Prabhakar Rajiah
- Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | | | - Michael Bolen
- Imaging Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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29
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Liddy S, McQuade C, Walsh KP, Loo B, Buckley O. The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning. Curr Cardiol Rep 2019; 21:103. [DOI: 10.1007/s11886-019-1196-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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30
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Bonou M, Kapelios CJ, Marinakos A, Adamopoulos S, Diamantopoulos P, Foukas PG, Kaklamanis L, Korkolopoulou P, Barbetseas J, Viniou NA. Diagnosis and treatment complications of primary cardiac lymphoma in an immunocompetent 28-year old man: a case report. BMC Cancer 2019; 19:191. [PMID: 30823905 PMCID: PMC6397455 DOI: 10.1186/s12885-019-5405-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/25/2019] [Indexed: 01/22/2023] Open
Abstract
Background Primary cardiac lymphomas (PCL) represent extremely rare cardiac tumors which are accompanied by poor prognosis, unless they are timely diagnosed and treated. Case presentation Herein we present a 28-year-old, immunocompetent man who presented to our hospital due to progressively worsening symptoms and signs of superior vena cava syndrome. Multi-modality imaging demonstrated a large intracardiac tumor, which was proven, by biopsy, to be a PCL. The patient received targeted chemotherapy which led to total remission of his disease, with no relapse over a 15-month follow-up period. Conclusions Although PCLs are rare, they should always be kept in mind in the differential diagnosis of cardiac tumors. Timely diagnosis of PCLs and appropriate chemotherapy, alone or in combination with radiotherapy, seems to provide the best results.
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Affiliation(s)
- Maria Bonou
- Cardiology Department, Laiko General Hospital, 17 Agiou Thoma Street, 11 527, Athens, Greece.
| | - Chris J Kapelios
- Cardiology Department, Laiko General Hospital, 17 Agiou Thoma Street, 11 527, Athens, Greece
| | - Athanasios Marinakos
- Cardiology Department, Laiko General Hospital, 17 Agiou Thoma Street, 11 527, Athens, Greece
| | - Stamatis Adamopoulos
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Panagiotis Diamantopoulos
- Hematology Unit, 1st Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Laiko General Hospital, Athens, Greece
| | - Periklis G Foukas
- 2nd Department of Pathology, National and Kapodistrian University of Athens School of Medicine, Attikon University Hospital, Athens, Greece
| | - Loukas Kaklamanis
- Department of Pathology, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Penelope Korkolopoulou
- 1st Department of Pathology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - John Barbetseas
- Cardiology Department, Laiko General Hospital, 17 Agiou Thoma Street, 11 527, Athens, Greece
| | - Nora-Athina Viniou
- Hematology Unit, 1st Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Laiko General Hospital, Athens, Greece
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31
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Quiroz E, Hafeez A, Mando R, Yu Z, Momin F. A Malignant Squeeze: A Rare Cause of Cardiac Tamponade. Case Rep Oncol Med 2018; 2018:5470981. [PMID: 30345132 DOI: 10.1155/2018/5470981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/04/2018] [Indexed: 11/28/2022] Open
Abstract
Primary cardiac lymphoma (PCL) is a rare condition described as a lymphoma localized to the heart or pericardium. Although cardiac involvement is seen in 10–20% of non-Hodgkin's lymphomas, PCL is extremely rare. It comprises merely 0.5% of all lymphomas and 1.3–2% of cardiac malignancies. Early detection is essential to avoid potentially fatal complications, and prognosis is highly dependent on the management of cardiac complications. The etiology of PCL is still unknown, and molecular characterization has yet to be studied leaving a great deal of research to be done in order to gain a better understanding of this rare disease process. We discuss the case of an 85-year-old female presenting with dyspnea and chest pain. Computed tomography of the chest revealed a pericardial effusion, and subsequent echocardiogram demonstrated a large circumferential effusion. She underwent emergent pericardiocentesis. Morphologic and immunophenotypic features were consistent with high-grade B-cell lymphoma with t(8; 14), and the patient was started on rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) with excellent response.
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Endo Y, Nakamura Y, Kuroda M, Nakanishi Y, Ito Y, Hori T, Okamoto R, Konishi H. Treatment of malignant primary cardiac lymphoma with tumor resection using minimally invasive cardiac surgery. J Cardiothorac Surg 2018; 13:97. [PMID: 30257692 PMCID: PMC6158874 DOI: 10.1186/s13019-018-0778-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/27/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary cardiac lymphoma (PCL) is extremely rare and progresses rapidly. The treatment of PCL has not yet been established. Unlike lymphoma that arises from other organs, PCL causes cardiovascular events. We report the complete remission (CR) of PCL after tumor resection using minimally invasive cardiac surgery (MICS) and chemotherapy. CASE PRESENTATION The patient was a 79-year-old man who visited our hospital with chief complaints of weight loss and leg edema. A 40 × 30 mm mobile pedunculated tumor continuous with the right ventricular heart muscle was present in the right atrium upon echocardiography and extended cardiac surgery was difficult to perform. Tumor embolism-induced sudden death was prevented and a pathological diagnosis was obtained by making a 4-cm skin incision, and tumor resection with MICS was performed through a right fourth intercostal thoracotomy with a cardiopulmonary system. The histopathological diagnosis was diffuse large B cell malignant lymphoma. Eight cycles of postoperative rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy were performed. Three years after surgery, the tumor was not visible on imaging and CR was maintained. CONCLUSIONS This case highlights that tumor resection using MICS is effective for avoiding the risk of sudden death. This technique was useful for the diagnosis and treatment of a malignant cardiac tumor in an elderly patient that required a difficult extended cardiac surgery.
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Affiliation(s)
- Yuki Endo
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1, Kanegasaku, Matsudo-shi, Chiba, 270-2251 Japan
| | - Yoshitsugu Nakamura
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1, Kanegasaku, Matsudo-shi, Chiba, 270-2251 Japan
| | - Miho Kuroda
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1, Kanegasaku, Matsudo-shi, Chiba, 270-2251 Japan
| | - Yusuke Nakanishi
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1, Kanegasaku, Matsudo-shi, Chiba, 270-2251 Japan
| | - Yujiro Ito
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1, Kanegasaku, Matsudo-shi, Chiba, 270-2251 Japan
| | - Takaki Hori
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1, Kanegasaku, Matsudo-shi, Chiba, 270-2251 Japan
| | - Rumiko Okamoto
- Departments of Oncology, Chiba-Nishi General Hospital, 107-1, Kanegasaku, Matsudo-shi, Chiba, 270-2251 Japan
| | - Hiroshi Konishi
- Departments of Hematology, Chiba-Nishi General Hospital, 107-1, Kanegasaku, Matsudo-shi, Chiba, 270-2251 Japan
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Abstract
Engineered cardiac tissue might enable novel therapeutic strategies for the human heart in a number of acquired and congenital diseases. With recent advances in stem cell technologies, namely the availability of pluripotent stem cells, the generation of potentially autologous tissue grafts has become a realistic option. Nevertheless, a number of limitations still have to be addressed before clinical application of engineered cardiac tissue based on human stem cells can be realized. We summarize current progress and pending challenges regarding the optimal cell source, cardiomyogenic lineage specification, purification, safety of genetic cell engineering, and genomic stability. Cardiac cells should be combined with clinical grade scaffold materials for generation of functional myocardial tissue in vitro. Scale-up to clinically relevant dimensions is mandatory, and tissue vascularization is most probably required both for preclinical in vivo testing in suitable large animal models and for clinical application. Graphical Abstract.
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Affiliation(s)
- Monica Jara Avaca
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Department for Cardiothoracic, Vascular and Transplantation Surgery (HTTG), Hannover Medical School (MHH) & Cluster of Excellence REBIRTH, Hannover, Germany
| | - Ina Gruh
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Department for Cardiothoracic, Vascular and Transplantation Surgery (HTTG), Hannover Medical School (MHH) & Cluster of Excellence REBIRTH, Hannover, Germany.
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Cichowska-Cwalińska N, Dutka M, Klapkowski A, Pęksa R, Maciej Zaucha J, Zaucha R. The role of radiotherapy in the management of primary cardiac lymphoma a case report and the literature review. Leuk Lymphoma 2018; 60:812-816. [DOI: 10.1080/10428194.2018.1509321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Magdalena Dutka
- Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrzej Klapkowski
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Rafał Pęksa
- Department of Patomorphology, Medical University of Gdańsk, Gdańsk, Poland
| | - Jan Maciej Zaucha
- Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk, Poland
| | - Renata Zaucha
- Department of Clinical Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
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35
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Amari K, Tago M, Katsuki NE, Fukumori N, Yamashita SI. Cardiac Recurrence of Diffuse Large B-cell Lymphoma More Than a Decade After Attaining Complete Remission. Am J Case Rep 2018; 19:1057-1062. [PMID: 30177676 PMCID: PMC6135044 DOI: 10.12659/ajcr.910787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Patient: Female, 79 Final Diagnosis: Cardiac recurrence of DLBCL Symptoms: Cardiogenic shock Medication: — Clinical Procedure: Biopsy specimen Specialty: Cardiology/Hematology
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Affiliation(s)
- Kaori Amari
- Department of General Medicine, Saga University Hospital, Saga City, Saga, Japan.,Department of Emergency Medicine, Saga-Ken Medical Centre, Koseikan, Saga City, Saga, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga City, Saga, Japan
| | - Naoko E Katsuki
- Department of General Medicine, Saga University Hospital, Saga City, Saga, Japan
| | - Norio Fukumori
- Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, Saga City, Saga, Japan
| | - Shu-Ichi Yamashita
- Department of General Medicine, Saga University Hospital, Saga City, Saga, Japan
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Taylor JE, Harless A, Shah S, Huang L, Gilliland YE, Qamruddin S. Large Primary Cardiac Lymphoma Causing Functional Tricuspid Valve Stenosis. Tex Heart Inst J 2018; 45:275-276. [PMID: 30374246 DOI: 10.14503/thij-17-6413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mendelson L, Hsu E, Chung H, Hsu A. Primary Cardiac Lymphoma: Importance of Tissue Diagnosis. Case Rep Hematol 2018; 2018:6192452. [PMID: 30147970 DOI: 10.1155/2018/6192452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/03/2018] [Indexed: 01/12/2023] Open
Abstract
Primary cardiac lymphoma (PCL) is a rare disease entity that can present with severe cardiac and cardioembolic symptoms. We present a 79-year-old male with history of polymalgia rheumatica on chronic prednisone who presented with a two-week history of progressively worsening dyspnea, cough, and a 10 pound weight loss. Transthoracic echocardiogram (TTE) and computed tomography (CT) of the chest showed a large mediastinal mass with invasion of the pericardium. A biopsy of an abdominal soft-tissue mass confirmed the diagnosis of PCL. The patient was treated with two cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) which was complicated by progressive heart failure requiring substitution of liposomal doxorubicin. The epidemiology, presentation, diagnosis, and treatment options of PCL are discussed.
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Li YH, Shi CY, Duan FQ, Pang Y, Li HB, Zhang LQ, Liu ZH, Ouyang L, Yue CY, Xie MC, Jiang ZJ, Xiao Y. [A clinical analysis of 10 cases with cardiac lymphoma]. Zhonghua Xue Ye Xue Za Zhi 2018; 38:102-106. [PMID: 28279032 PMCID: PMC7354164 DOI: 10.3760/cma.j.issn.0253-2727.2017.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
目的 分析心脏淋巴瘤的发病情况、临床特征、治疗效果及预后。 方法 收集2000年1月至2016年6月期间确诊并有心脏累及的10例淋巴瘤患者的资料,对患者的一般资料、临床表现、病理诊断、实验室检查、心脏累及方式、心脏并发症、治疗方式、疗效及预后进行分析。 结果 3 918例淋巴瘤患者中,心脏累及者10例,其中原发性心脏淋巴瘤(PCL)1例(主要累及左右心房,以心肌内多发结节包块为主),继发性心脏淋巴瘤(SCL)9例(主要为心包包块,其中出现心包积液5例,心肌肿块2例)。男性6例,女性4例,中位年龄55(19~88)岁,主要临床表现为呼吸困难7例,胸痛5例,乏力、水肿各2例。病理类型包括弥漫大B细胞淋巴瘤(DLBCL)7例,T淋巴母细胞淋巴瘤、霍奇金淋巴瘤、Burkitt淋巴瘤各1例。心脏并发症包括充血性心力衰竭7例,心律失常4例(主要为窦性心动过速、心房颤动和房室传导阻滞)。除1例高龄、一般状况差未接受治疗外,其余9例患者均接受治疗(单纯化疗4例,化疗联合放疗5例)。中位随访时间为9(1~28)个月。1例PCL患者化疗后获部分缓解(PR),无进展生存(PFS)期为6个月,总生存(OS)期为21个月。SCL患者中6例起病累及心脏者,治疗后1例获完全缓解,5例获PR,中位PFS期为5个月,中位OS期为19个月;3例病情进展累及心脏者,2例治疗后获PR,1例未治疗者死亡,中位PFS期为4个月,OS因数据截尾,未能获得。 结论 心脏淋巴瘤为少见类型,DLBCL为最常见类型,呼吸困难、胸痛为最常见临床表现,并易出现充血性心力衰竭和心律失常,治疗以系统化疗为主,总体预后差。
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Affiliation(s)
- Y H Li
- Department of Hematology, Guangzhou Military Command Guangzhou General Hospital, Guangzhou 510010, China
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Pattnaik MK, Sahoo SP, Panigrahy SK, Das U. Primary cardiac diffuse B cell lymphoma presenting with right heart failure: a case report and review of literature. Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-017-0538-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Palaskas N, Thompson K, Gladish G, Agha AM, Hassan S, Iliescu C, Kim P, Durand JB, Lopez-Mattei JC. Evaluation and Management of Cardiac Tumors. Curr Treat Options Cardiovasc Med. 2018;20:29. [PMID: 29556752 DOI: 10.1007/s11936-018-0625-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Our purpose is to discuss the importance of multimodality imaging in the assessment of cardiac tumors and management. We have compiled a recent review of the scientific literature and embedded our clinical pathways and recommendations based on data and clinical experience. RECENT FINDINGS The use of contrast echocardiography in the assessment of cardiac masses has been shown to be helpful in distinguishing tumor from thrombus. Deformation imaging of cardiac tumors has been shown to differentiate better rhabdomyomas from fibromas in pediatric patients. Cardiac MRI (CMR) appears to be helpful in determining whether cardiac tumors are benign or malignant by identifying presence of infiltration, uptake of contrast in first pass perfusion and gadolinium enhancement. Patients with evidence of cardiac metastases by CMR show similar survival to stage IV cancer without cardiac metastases. In our institution, we use a standardized approach for the evaluation of cardiac masses, which includes multimodality imaging in the appropriate clinical context. The autotransplantation surgical technique has shown some promise in improving survival in patients with primary cardiac sarcomas. In our institution, we do not routinely recommend anticoagulation for "tumor-thrombus" in renal cell carcinoma due to risk of bleeding from primary tumor. Cardiac masses are often found incidentally, but sometimes can present with cardiovascular symptoms due to obstruction and valvular dysfunction, which may prompt imaging. It is important to determine whether the mass is a normal variant, imaging artifact, vegetation, thrombus, or tumor. Transthoracic echocardiography is ideally suited to be the initial imaging modality because of the portability, wide availability, lack of radiation, and relatively low cost. The gold standard cardiac imaging technique to distinguish tumor from thrombus is contrast enhanced CMR with prolonged inversion time. Advantages of CMR when compared to echocardiography regarding characterization of cardiac tumors are as follows: larger field of view, better spatial resolution, better tissue characterization, lack of attenuation, and ability to image at any prescribed plane. Primary and secondary cardiac tumors have particular characteristics in echocardiography and CMR. Imaging of cardiac tumors plays an important role in establishing a diagnosis and in planning management.
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Abstract
BACKGROUND Cardiac magnetic resonance imaging (MRI) is emerging as an important diagnostic modality in the management of cardiovascular-related dysfunction in oncological diseases. Advances in imaging techniques have enhanced the detection and evaluation of cardiac masses; meanwhile, innovative applications have created a growing role for cardiac MRI for the management of cardiotoxicity caused by cancer therapies. METHODS An overview is provided of the clinical indications and technical considerations of cardiac MRI. Its role in the evaluation of cardiac masses and cardiac function is reviewed, and novel sequences are discussed that are giving rise to future directions in cardio-oncology research. A review of the literature was also performed, focusing on cardiac MRI findings associated with cardiac dysfunction related to cancer treatment. RESULTS Cardiac MRI can be used to differentiate benign and malignant primary cardiac tumors, metastatic disease, and pseudotumors with high spatial and temporal resolution. Cardiac MRI can also be used to detect the early and long-term effects of cardiotoxicity related to cancer therapy. This is accomplished through a multiparametric approach that uses conventional bright blood, dark blood, and postcontrast sequences while also considering the applicability of newer T1 and T2 mapping sequences and other emerging techniques. CONCLUSIONS Cardio-oncology programs have an expanding presence in the multidisciplinary approach of cancer care. Consequently, knowledge of cardiac MRI and its potential applications is critical to the success of contemporary cancer diagnostics and cancer management.
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Affiliation(s)
- Daniel Jeong
- Department of Radiology, Moffitt Cancer Center, Tampa, FL.
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Sherkat R, Sabri MR, Dehghan B, Bigdelian H, Reisi N, Afsharmoghadam N, Rahimi H, Rahmanian N, Klein C. EBV lymphoproliferative-associated disease and primary cardiac T-cell lymphoma in a STK4 deficient patient: A case report. Medicine (Baltimore) 2017; 96:e8852. [PMID: 29310365 PMCID: PMC5728766 DOI: 10.1097/md.0000000000008852] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
RATIONALE Primary cardiac lymphoma (PLC) is an extremely uncommon malignancy. PCL is more common in secondary immunodeficient patients. In this report, we describe a unique case of PLC who had been diagnosed as a STK4 deficient patient. This case is the first Primary immunodeficiency (PID) patient developing PCL in the world. PATIENT CONCERNS An eleven-year-old girl, a known case of PID, was referred to the pediatric cardiology department because of chest pain and dyspnea. Her CXR revealed cardiomegaly without mediastinal involvement and the echocardiography showed a mild pericardial effusion and cystic-shape echogenic masses. DIAGNOSES After a period of missed follow up, she presented with respiratory distress following with syncope at the clinic because of a pressure effect of a large mass on the right ventricular outflow tract (RVOT) .An emergency operation was done for debulking of the tumors and resolving of RVOT obstruction. Biopsy and immunohistochemical staining was revealing "T-cell lymphoma", non-Hodgkin's type. INTERVENTIONS Chemotherapy was done with cyclophosphamide, methotrexate, adriamycine, vincristine, hydrocortisone and allopurinol. OUTCOMES The tumors shrank after chemotherapy initiation and she stayed stable for almost one month. Finally, she developed sever thrombocytopenia during her chemotherapy and died because of lung hemorrhage two months after her operation. LESSONS Although PCL is very rare, it must be considered in the differential diagnosis of intracardiac mass or refractory pericardial effusions, especially in PIDs which are widely known for developing EBV-associated diseases such as lymphoma.
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Affiliation(s)
| | - Mohammad Reza Sabri
- Pediatric Cardiovascular Research Center, Isfahan Cardiovascular Research Institute
| | - Bahar Dehghan
- Pediatric Cardiovascular Research Center, Isfahan Cardiovascular Research Institute
| | | | - Nahid Reisi
- Pediatric Cardiovascular Research Center, Isfahan Cardiovascular Research Institute
| | | | - Hamid Rahimi
- Pediatric Cardiovascular Research Center, Isfahan Cardiovascular Research Institute
| | | | - Cristoph Klein
- Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
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Cereda AF, Moreo AM, Sormani P, De Chiara B, Casadei F, Zancanella M, Rusconi C, Cairoli R, Giannattasio C. Impact of serial echocardiography in the management of primary cardiac lymphoma. J Saudi Heart Assoc. 2018;30:160-163. [PMID: 29910591 PMCID: PMC6000892 DOI: 10.1016/j.jsha.2017.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/23/2017] [Accepted: 08/08/2017] [Indexed: 01/17/2023] Open
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Sarr SA, Gaye AM, Aw F, de Dieu Nzambaza J, Bodian M, Babaka K, Ndiaye MB, Kane A, Diao M, Ba SA. Obstructive Primary Cardiac T-Cell Lymphoma: A Case Report from Senegal. Am J Case Rep 2017; 18:281-285. [PMID: 28316327 PMCID: PMC5374889 DOI: 10.12659/ajcr.901455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiac lymphoma is a rare entity, defined by the non-extra cardiac location at diagnosis. CASE REPORT Our patient was a 32-year-old female with no particular medical history, who presented with right heart failure with recurrent ascites and pleural effusion. There was a progressive worsening exertional dyspnea. On admission, examination revealed an irregular tachycardia at 170 beats per minute (bpm) and congestive heart failure. The electrocardiogram scored full tachyarrhythmia by atrial fibrillation with an average ventricular rate of 179 cycles per minute. Doppler echocardiography showed dilatation and systolic dysfunction of the left ventricle. There were dilated atria. We noted a large mass in the right atrium, which was less mobile, heterogeneous, integral with the wall, and filling three quarters of the cavity. It clogged the tricuspid valve in diastole. CT scan showed a tissue process enhanced after contrast injection, occupying the predominant cavities in the right atrium and filling it. Its borders were irregular. The lesion was extended to the posterior mediastinum, in front of the vertebral axis. In addition, there was a thrombosis of the jugular vein and the inferior vena cava. There was no other tumor site noted. The patient died after presenting with cardiovascular shock associated with refractory right heart failure. Pathology examination confirmed T-cell lymphoma. CONCLUSIONS The primitive cardiac lymphoma is an entity of intra-cardiac masses. It is therefore to be considered even if the diagnosis is challenging.
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Affiliation(s)
- Simon Antoine Sarr
- Department of Cardiology, Teaching Hospital Aristide Le Dantec, Dakar, Senegal
| | - Abdou Majib Gaye
- Department of Anatomopathology, Teaching Hospital Aristide Le Dantec, Dakar, Senegal
| | - Fatou Aw
- Department of Cardiology, Teaching Hospital Aristide Le Dantec, Dakar, Senegal
| | | | - Malick Bodian
- Department of Cardiology, Teaching Hospital Aristide Le Dantec, Dakar, Senegal
| | - Kana Babaka
- Department of Cardiology, Teaching Hospital Aristide Le Dantec, Dakar, Senegal
| | | | - Adama Kane
- Department of Cardiology, Teaching Hospital Aristide Le Dantec, Dakar, Senegal
| | - Maboury Diao
- Department of Cardiology, Teaching Hospital Aristide Le Dantec, Dakar, Senegal
| | - Serigne Abdou Ba
- Department of Cardiology, Teaching Hospital Aristide Le Dantec, Dakar, Senegal
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Kuroda M, Sakamoto T, Orihara M, Saito S. Two- and Three-Dimensional Transesophageal Echocardiography for Two Separate Primary Cardiac Lymphomas in the Right Heart. Anesth Analg 2017; 125:44-47. [PMID: 28118161 DOI: 10.1213/ane.0000000000001875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Masataka Kuroda
- From the Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan
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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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Mauricio R, Mgbako O, Buntaine A, Moreira A, Jung A. Complete Resolution of Tumor Burden of Primary Cardiac Non-Hodgkin's Lymphoma. Case Rep Cardiol 2016; 2016:2124975. [PMID: 28101382 DOI: 10.1155/2016/2124975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/04/2016] [Indexed: 01/04/2023] Open
Abstract
Primary cardiac tumors are a rare set of benign and malignant neoplasms found in the heart or pericardium. We describe a patient presenting with nonspecific symptoms and ultimately diagnosed with primary cardiac non-Hodgkin's lymphoma (PCL). Our patient had extensive tumor in the right ventricle, which extended into the right atrium and right ventricular outflow tract. The tumor also encased the right coronary artery, which manifested as ischemic changes on EKG and cardiac MRI. The patient was treated with chemotherapy and achieved complete remission, with dramatic and full resolution of the mass on repeat echocardiography in nine weeks. More studies are needed to understand the optimal management and prognosis of patients with PCL.
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Abstract
Primary cardiac tumors are rare, with an incidence of 0.056% according to autopsy reports. The most common type is myxoma, while other types, including sarcoma, lipoma, papillary fibroelastoma, rhabdomyoma, fibroma, hemangioma, teratoma, lymphoma and mesothelioma also occur. Primary cardiac tumors usually cause embolization, pericardial effusion and arrhythmia, leading to heart failure. Only 10% of primary cardiac tumors are malignant, approximately 95% of which are sarcomas, while the remaining 5% are cardiac lymphomas and mesotheliomas. The present study reported a case of primary cardiac lymphoma (PCL) with bilateral renal involvement and a case of PCL with bilateral adrenal gland involvement. The prognosis of PCL is poor due to the low rate of early detection and treatment. The definitive diagnosis is dependent on pathology, and timely treatment with chemotherapy can be effective. The two cases developed life-threatening arrhythmia and responded to the initial chemotherapy. In the first case, complete remission was achieved after finalization of therapy. However, the second case refused further chemotherapy and succumbed to his condition after two months.
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Affiliation(s)
- Chiu-Fan Chen
- Department of Chest Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan, R.O.C
| | - Pin-Pen Hsieh
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan, R.O.C
| | - Shyh-Jer Lin
- Department of Hematology and Oncology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan, R.O.C
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Singh B, Ip R, Ibrahim Al-Rajjal A, Kafri Z, Al-Katib A, Hadid T. Primary Cardiac Lymphoma: Lessons Learned from a Long Survivor. Case Rep Cardiol 2016; 2016:7164829. [PMID: 28053792 DOI: 10.1155/2016/7164829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [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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