1
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Maturu VN, Prasad VP, Vaddepally CR, Sethi S. Endobronchial ultrasound guided intracardiac needle aspiration (EBUS-ICNA). BMJ Case Rep 2022; 15:e249279. [PMID: 35817483 PMCID: PMC9274520 DOI: 10.1136/bcr-2022-249279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/03/2022] Open
Abstract
Most cardiac tumours are secondary to metastasis from extracardiac tumours. Obtaining biopsy from intracardiac lesions, especially from the left heart, is challenging, and the conventionally used methods are invasive and involve significant risks such as arrhythmias, tamponade, valvular damage and tumour embolisation. Endobronchial ultrasound (EBUS) is a minimally invasive procedure used to biopsy lymph nodes or mass lesions adjacent to the airways. Its safety and usefulness have been well established. Use of EBUS has expanded to several novel indications over the last few years. Here we report a case of a young woman with suspected metastatic disease to the heart, in whom traditional methods of biopsy had failed to give a diagnosis. EBUS-guided transbronchial intracardiac needle aspiration was safely performed from the left atrial mass lesion to obtain tissue for histopathological diagnosis. A diagnosis of metastatic adenocarcinoma with tumour embolisation to the heart was established.
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Affiliation(s)
- Venkata Nagarjuna Maturu
- Pulmonary Medicine, Yashoda Super Specialty Hospitals Somajiguda Hyderabad, Hyderabad, Telangana, India
| | - Virender Pratibh Prasad
- Pulmonary Medicine, Yashoda Super Specialty Hospitals Somajiguda Hyderabad, Hyderabad, Telangana, India
| | - Chetan Rao Vaddepally
- Pulmonary Medicine, Yashoda Super Specialty Hospitals Somajiguda Hyderabad, Hyderabad, Telangana, India
| | - Shweta Sethi
- Department of Pathology, Yashoda Super Specialty Hospitals Somajiguda Hyderabad, Hyderabad, Telangana, India
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2
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Chang L, Gong C, Lu H, Liu Y, Kang L, Chen J, Wang L, Xu B. Percutaneous intravenous catheter forceps biopsy in right atrial mass: two case reports and literature review. BMC Cardiovasc Disord 2022; 22:63. [PMID: 35184743 PMCID: PMC8859873 DOI: 10.1186/s12872-022-02507-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/10/2022] [Indexed: 12/17/2022] Open
Abstract
Background Primary malignant tumors of the heart are rare. Although preoperative histological diagnosis is difficult, it has paramount value in therapeutic strategy development and prognostic estimation. Herein, we reported 2 cases of intracardiac tumors. Cases presentation Both patients presented to the hospital with heart-related symptoms. Echocardiography showed massive masses in the atrium and positron emission tomography–computed tomography (PET/CT) revealed hypermetabolism and invasiveness. One patient cannot take surgery due to extensive metastasis and poor condition. The other patient was primarily diagnosed with lymphoma, and surgery was not recommended. They successfully underwent intravenous atrial biopsy, and histological samples confirmed intimal sarcoma and diffuse large B cell lymphoma. Based on immunohistochemical and molecular assessments, targeted chemotherapy was administered, resulting in clinical and imaging remission at discharge. Conclusions Percutaneous intravenous catheter biopsy as a safe invasive test provides an accurate pathological diagnosis after imaging evaluation, and offers a therapeutic direction. Nonmalignant masses and some chemo-radiosensitive malignant tumors in the atrium could have good prognosis after targeted therapy.
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3
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An unusual case of cardiac lymphoma diagnosed using computed tomographyguided percutaneous transthoracic biopsy. Anatol J Cardiol 2021; 24:59-61. [PMID: 32628149 PMCID: PMC7414806 DOI: 10.14744/anatoljcardiol.2020.95079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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4
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Zhao Y, Huang S, Ma C, Zhu H, Bo J. Clinical features of cardiac lymphoma: an analysis of 37 cases. J Int Med Res 2021; 49:300060521999558. [PMID: 33752450 PMCID: PMC7995496 DOI: 10.1177/0300060521999558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To summarize the clinical and pathological features of patients with cardiac lymphoma. METHODS The general conditions, clinical features, pathological types, and prognostic indices of 37 patients with cardiac lymphoma treated in our hospital were analyzed. RESULTS Among the 37 patients, only one had primary cardiac lymphoma, and the other 36 patients had secondary cardiac lymphoma. The cardiac manifestations were mainly chest tightness, shortness of breath, increased heart rates, and electrocardiographic abnormality caused by pericardial effusion, but myocardial enzyme levels were normal in all patients. Only three patients displayed solid heart-occupying manifestations. These lesions were mainly located in the right atrium, and the masses were all larger than 5 cm. The pathological type was diffuse large B cell lymphoma that did not arise from the germinal center in all three patients. CONCLUSIONS Cardiac lymphoma was mostly secondary, and pericardial effusion was the primary objective sign. Moreover, cardiac lymphoma was characterized by a high international prognostic index, late stage, and high rates of T and NK cell lymphoma. Most cases were accompanied by serous cavity effusion, extranodal involvement of important organs, elevated lactate dehydrogenase levels, hypoalbuminemia, and normal myocardial enzyme levels.
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Affiliation(s)
- Yu Zhao
- Department of Hematology, First Medical Center, 104607Chinese PLA General Hospital, Beijing, China
| | - Sai Huang
- Department of Hematology, First Medical Center, 104607Chinese PLA General Hospital, Beijing, China
| | - Chao Ma
- Department of Hematology, First Medical Center, 104607Chinese PLA General Hospital, Beijing, China
| | - Haiyan Zhu
- Department of Hematology, First Medical Center, 104607Chinese PLA General Hospital, Beijing, China
| | - Jian Bo
- Department of Hematology, First Medical Center, 104607Chinese PLA General Hospital, Beijing, China
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5
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Joseph G, Zelechowski MW, Gronlund J, Zaremba T. The challenge in diagnosing cardiac tumors to avoid unnecessary cardiac surgery. Clin Case Rep 2020; 8:1714-1718. [PMID: 32983483 PMCID: PMC7495774 DOI: 10.1002/ccr3.2973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/16/2020] [Accepted: 04/21/2020] [Indexed: 12/22/2022] Open
Abstract
Cardiac magnetic resonance in cardiac mass: Cardiac magnetic resonance (CMR) should be considered in the evaluation of patients with cardiac mass. Especially, when the diagnosis is not certain, CMR could provide paramount information that could be helpful for the decision on cardiac surgery.
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Affiliation(s)
- Gowsini Joseph
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
- Department of Cardiology & Centre for Clinical ResearchNorth Denmark Regional HospitalHjorringDenmark
- Department of CardiologyZealand University HospitalUniversity of CopenhagenRoskildeDenmark
| | | | - Jens Gronlund
- Department of Cardiothoracic SurgeryAalborg University HospitalAalborgDenmark
| | - Tomas Zaremba
- Department of CardiologyAalborg University HospitalAalborgDenmark
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6
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Casavecchia G, Lestuzzi C, Gravina M, Corrado G, Tusa M, Brunetti ND, Manuppelli V, Monte IP. Cardiac Tumors. J Cardiovasc Echogr 2020; 30:S45-S53. [PMID: 32566466 PMCID: PMC7293869 DOI: 10.4103/jcecho.jcecho_7_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/16/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023] Open
Abstract
Cardiac tumors (CTs) are extremely rare, with an incidence of approximately 0.02% in autopsy series. Primary tumors of the heart are far less common than metastatic tumors. CTs usually present with any possible clinical combination of heart failure, arrhythmias, or embolism. Echocardiography remains the first diagnostic approach when suspecting a CT which, on the other side, frequently appears unexpectedly during an echocardiographic examination. Yet, cardiac tomography and especially magnetic resonance imaging may offer several adjunctive opportunities in the diagnosis of CTs. Early and exact diagnosis is crucial for the following therapy and outcome of CTs.
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Affiliation(s)
| | - Chiara Lestuzzi
- Department of Cardiology, Aviano Hospital, Pordenone, Aviano, Italy
| | - Matteo Gravina
- Department of Radiology, University of Foggia, Foggia, Italy
| | | | - Maurizio Tusa
- Department of Cardiology, Milano San Donato Hospital, Milano, Italy
| | | | | | - Ines Paola Monte
- Department of General Surgery and Medical-Surgery Specialities, University of Catania, Catania, Italy
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7
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Katagiri S, Akahane D, Suguro T, Furuya N, Fujimoto H, Saito T, Yamashita J, Nakamura N, Ohyashiki K. Cardiac biopsy with intracardiac echocardiographic guidance for successful diagnosis of cardiac lymphoma. Clin Case Rep 2018; 6:1681-1683. [PMID: 30214741 PMCID: PMC6132102 DOI: 10.1002/ccr3.1699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/06/2018] [Accepted: 06/17/2018] [Indexed: 11/16/2022] Open
Abstract
The diagnosis and appropriate treatment of cardiac lymphoma are often delayed by the difficulty in obtaining heart tissue biopsies. Intracardiac echocardiography-guided biopsy can improve the prognosis of cardiac lymphoma by decreasing postbiopsy complications and increasing biopsy quality, allowing collection of sufficient material for multilateral analysis.
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Affiliation(s)
| | - Daigo Akahane
- Department of HematologyTokyo Medical UniversityTokyoJapan
| | - Tamiko Suguro
- Department of HematologyTokyo Medical UniversityTokyoJapan
| | - Nahoko Furuya
- Department of HematologyTokyo Medical UniversityTokyoJapan
| | | | - Tetsushi Saito
- Department of CardiologyTokyo Medical UniversityTokyoJapan
| | - Jun Yamashita
- Department of CardiologyTokyo Medical UniversityTokyoJapan
| | - Naoya Nakamura
- Department of PathologyTokai University School of MedicineKanagawaJapan
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8
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Weinberg L, Abu-Ssaydeh D, Macgregor C, Wang J, Wong C, Spanger M, Muralidharan V. Transjugular biopsy case report of inferior vena cava hepatocellular carcinoma with intracardiac extension. Int J Surg Case Rep 2017; 39:324-327. [PMID: 28898796 PMCID: PMC5597876 DOI: 10.1016/j.ijscr.2017.08.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 08/31/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Diagnosis of hepatocellular carcinoma (HCC) can be established with near certainty by correlating radiological imaging with clinical presentation. However, in the absence of diagnostic certainty, biopsy of liver tissue is mandatory for optimal management. We present our management of a patient with advanced liver disease who presented with an IVC mass extending into the right atrium, with co-existing liver lesions not meeting criteria for an imaging diagnosis of HCC. CASE PRESENTATION A 62-year-old male with Child-Pugh C liver cirrhosis presented with decompensated liver failure. Multiple imaging modalities demonstrated an inferior vena cava (IVC) mass extending into the right atrium with co-existing liver lesions not meeting radiological criteria for an imaging diagnosis of HCC. There was no contiguous evidence of HCC in the liver, yet there was extensive tumour burden in the IVC representing a separate metastatic lesion without any indication of direct tumour spread. Under fluoroscopic and angiographic guidance, a biopsy catheter was advanced through the right atrium into the IVC. Histology from the biopsy demonstrated fragments of malignant tumour with features consistent with moderately differentiated HCC without thrombus. Given the poor prognosis associated with metastatic HCC with IVC and intracardiac involvement, a multidisciplinary decision was made with the patient's family for palliation care. CONCLUSION Transjugular biopsy of IVC masses can be performed effectively, in an awake patient, without the need for sedation or anaesthesia. Where multiple imaging modalities fail to confirm a diagnosis for liver or IVC pathology, transluminal biopsy can assist with definitive diagnosis and treatment planning.
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Affiliation(s)
- Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, 3084, Australia; Department of Surgery, University of Melbourne, Austin Health, 8002, Victoria, Australia.
| | - Diana Abu-Ssaydeh
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, 3084, Australia.
| | - Chris Macgregor
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, 3084, Australia.
| | - Jason Wang
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, 3084, Australia.
| | - Clarence Wong
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, 3084, Australia.
| | - Manfred Spanger
- Department of Radiology, Box Hill Hospital, Box Hill, Victoria, 3128, Australia.
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9
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Jonavicius K, Salcius K, Meskauskas R, Valeviciene N, Tarutis V, Sirvydis V. Primary cardiac lymphoma: two cases and a review of literature. J Cardiothorac Surg 2015; 10:138. [PMID: 26518127 PMCID: PMC4628386 DOI: 10.1186/s13019-015-0348-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 10/28/2015] [Indexed: 11/15/2022] Open
Abstract
Background Primary cardiac lymphoma is one of the rarest tumours of the heart. It belongs to the extra-nodal non-Hodgkin’s lymphomas. The most common type of this tumour is diffuse large B cell lymphoma. Usually, right atrium and right ventricle are involved. This tumour is fatal unless diagnosed and treated in time. In this article two female patients who were diagnosed with primary cardiac lymphoma and treated at our clinic are described. The first patient went to remission after the treatment, while the second patient died. The goals of this article are to show the difficulties of diagnosing and treating this disease, the role of cardiac surgery in its treatment and to raise awareness of this disease. Case reports In this article two female patients who were diagnosed with primary cardiac lymphoma and treated at our clinic are described. The first patient went to remission after the treatment, while the second patient died. Conclusions Primary cardiac lymphoma is a very rare disease. At the moment the most effective treatment is chemotherapy. Palliative surgery may be necessary to correct hemodynamics when venous blood flow to the lungs is disturbed.
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Affiliation(s)
- Karolis Jonavicius
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania. .,Department of Cardiovascular Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. .,Vilnius University Faculty of Medicine Centre of Cardiac Surgery, Santariskiu g. 2, Vilnius, 08661, Lithuania.
| | - Kestutis Salcius
- Department of Cardiovascular Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Raimundas Meskauskas
- National Centre of Pathology, Affiliate of Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania.
| | - Nomeda Valeviciene
- Department of Radiology, Nuclear Medicine and Physics of Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Virgilijus Tarutis
- Department of Cardiovascular Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. .,Vilnius University Faculty of Medicine Centre of Cardiac Surgery, Santariskiu g. 2, Vilnius, 08661, Lithuania.
| | - Vytautas Sirvydis
- Department of Cardiovascular Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
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10
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Aledavood SA, Emadi Torghabeh A, Homaee Shandiz F, Memar B. Cardiac Involvement in Non-Hodgkin Lymphoma, an Incidental Large Atrial Mass: A Case Report. IRANIAN JOURNAL OF CANCER PREVENTION 2015; 8:e3913. [PMID: 26634111 PMCID: PMC4667233 DOI: 10.17795/ijcp-3913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/29/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Cardiac involvement as an initial presentation of malignant lymphoma has been a rare occurrence. CASE PRESENTATION We have reported a 78 year old man with complaint of abdominal pain and vomiting. In patients preoperative evaluation for surgical management of an intra-abdominal mass, a large intracardiac mass has found incidentally during the echocardiography. Pathologic biopsy of right atrial mass that has removed by open heart surgery shown: non Hodgkin-B cell lymphoma. Bone marrow biopsy was taken and was positive for lymphomatous involvement. CONCLUSIONS The patient has treated by CHOP chemotherapy regiment successfully and after completion of treatment, there was complete response.
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Affiliation(s)
- Seyed Amir Aledavood
- Cancer Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Ali Emadi Torghabeh
- Cancer Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Fateme Homaee Shandiz
- Cancer Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Bahram Memar
- Department of Patholgy, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
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11
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Carter BW, Wu CC, Khorashadi L, Godoy MCB, de Groot PM, Abbott GF, Lichtenberger JP. Multimodality imaging of cardiothoracic lymphoma. Eur J Radiol 2014; 83:1470-82. [PMID: 24935137 DOI: 10.1016/j.ejrad.2014.05.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 04/02/2014] [Accepted: 05/09/2014] [Indexed: 01/15/2023]
Abstract
Lymphoma is the most common hematologic malignancy and represents approximately 5.3% of all cancers. The World Health Organization published a revised classification scheme in 2008 that groups lymphomas by cell type and molecular, cytogenetic, and phenotypic characteristics. Most lymphomas affect the thorax at some stage during the course of the disease. Affected structures within the chest may include the lungs, mediastinum, pleura, and chest wall, and lymphomas may originate from these sites as primary malignancies or secondarily involve these structures after arising from other intrathoracic or extrathoracic sources. Pulmonary lymphomas are classified into one of four types: primary pulmonary lymphoma, secondary pulmonary lymphoma, acquired immunodeficiency syndrome-related lymphoma, and post-transplantation lymphoproliferative disorders. Although pulmonary lymphomas may produce a myriad of diverse findings within the lungs, specific individual features or combinations of features can be used, in combination with secondary manifestations of the disease such as involvement of the mediastinum, pleura, and chest wall, to narrow the differential diagnosis. While findings of thoracic lymphoma may be evident on chest radiography, computed tomography has traditionally been the imaging modality used to evaluate the disease and effectively demonstrates the extent of intrathoracic involvement and the presence and extent of extrathoracic spread. However, additional modalities such as magnetic resonance imaging of the thorax and (18)F-FDG PET/CT have emerged in recent years and are complementary to CT in the evaluation of patients with lymphoma. Thoracic MRI is useful in assessing vascular, cardiac, and chest wall involvement, and PET/CT is more accurate in the overall staging of lymphoma than CT and can be used to evaluate treatment response.
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Affiliation(s)
- Brett W Carter
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Section of Thoracic Imaging, 1515 Holcombe Blvd., Unit 1478, Houston, TX 77030, USA.
| | - Carol C Wu
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA 02114, USA
| | - Leila Khorashadi
- Department of Radiology, Mount Auburn Hospital, Cambridge, MA 02138, USA
| | - Myrna C B Godoy
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Section of Thoracic Imaging, 1515 Holcombe Blvd., Unit 1478, Houston, TX 77030, USA
| | - Patricia M de Groot
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Section of Thoracic Imaging, 1515 Holcombe Blvd., Unit 1478, Houston, TX 77030, USA
| | - Gerald F Abbott
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA 02114, USA
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12
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Cho JS, Her SH, Park MW, Kim HD, Baek JY, Youn HJ, Seung KB, Kim JH. A butterfly-shaped primary cardiac lymphoma that showed bi-atrial involvement. Korean Circ J 2012; 42:46-9. [PMID: 22363383 PMCID: PMC3283754 DOI: 10.4070/kcj.2012.42.1.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 10/30/2011] [Indexed: 11/11/2022] Open
Abstract
We described here a patient who presented with symptoms of heart failure who was found to have severe bilateral impairment of atrioventricular inflow. Primary cardiac lymphoma (PCL) with extensive involvement of the two atria, pericardium and myocardium is an extremely rare tumor in immunocompetent patients. We report here a case of PCL in an immunocompetent patient with involvement of both atria and the atrial septum. The tumor had a butterfly shape. We could not do surgical excision because of the massive pericardiac invasion. The diagnosis was B-cell lymphoma and this was confirmed by the pericardiac biopsy.
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Affiliation(s)
- Jung Sun Cho
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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13
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O'Mahony D, Peikarz RL, Bandettini WP, Arai AE, Wilson WH, Bates SE. Cardiac involvement with lymphoma: a review of the literature. ACTA ACUST UNITED AC 2009; 8:249-52. [PMID: 18765314 DOI: 10.3816/clm.2008.n.034] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Current literature suggests that the incidence of cardiac involvement by lymphoma as identified by autopsy varies widely, ranging from 8.7% to 20%. Historically, many cases might have been clinically undetected; however, improved imaging techniques increasingly identify cardiac involvement incidentally. In addition, newer agents resulting in improved cancer therapy outcomes might alter the prevalence and location of metastatic deposits to include more unusual disease sites, including intracardiac locations. We present 2 cases and a review of the literature.
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Affiliation(s)
- Deirdre O'Mahony
- Metabolism Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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14
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Higo T, Takemoto M, Ogawa K, Inoue S, Eshima KI, Tada H, Sunagawa K. Intracardiac Echocardiography-Guided Cardiac Tumor Biopsy. Circ J 2009; 73:381-3. [DOI: 10.1253/circj.cj-08-0043] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Masao Takemoto
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Kiyohiro Ogawa
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Shujiro Inoue
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Ken-ichi Eshima
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Hideo Tada
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Kenji Sunagawa
- Department of Cardiovascular Medicine, Kyushu University Hospital
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15
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Nascimento AF, Winters GL, Pinkus GS. Primary cardiac lymphoma: clinical, histologic, immunophenotypic, and genotypic features of 5 cases of a rare disorder. Am J Surg Pathol 2007; 31:1344-50. [PMID: 17721189 DOI: 10.1097/pas.0b013e3180317341] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary lymphomas of the heart are rare and frequently are diagnosed at autopsy. Modern imaging technology now permits early diagnosis and treatment. This report describes the clinical, histologic, immunophenotypic, and molecular genetic findings for 5 patients with malignant lymphoma restricted to the cardiac muscle, with or without pericardial involvement. All patients were women, with ages ranging from 40 to 68 years (median 55 y). The right atrium was involved in all cases with the left atrium, right ventricle, and pericardium affected in 1 case each. Clinical presentation included pericardial effusions associated with precordial pain, dyspnea, and bradycardia. Electrocardiographic changes included junctional rhythm, incomplete right bundle branch block and ST and T waves abnormalities, and ST segment elevation and first-degree atrioventricular block with intermittent complete heart block. In all cases, biopsy or resection of the lesion or cytologic examination of the pericardial fluid established a diagnosis. All tumors were of B-cell phenotype and included 4 cases of large cell lymphoma and one unclassifiable small cell lymphoma. In 2 cases, a follicular center cell origin was supported by reactivity of the neoplastic cells for CD10 and bcl-6 and by bcl-2 gene rearrangement by molecular analysis. One patient died shortly after diagnosis due to cerebral infarction. Two patients are alive without disease after chemotherapy with CHOP after 120 and 192 months. One patient underwent chemotherapy with CHOP and rituximab, and shows persistent cardiac involvement by lymphoma but with a decrease in tumor burden at 7 months of follow-up. One patient was lost to follow-up. Clinical outcome is variable; however, early diagnosis in conjunction with effective treatment (surgery and/or chemotherapy) may result in an excellent prognosis. Primary cardiac lymphoma should be included in the differential diagnosis of a right atrial mass.
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MESH Headings
- Adult
- Aged
- Antigens, CD/analysis
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/therapeutic use
- Diagnosis, Differential
- Doxorubicin/administration & dosage
- Doxorubicin/therapeutic use
- Female
- Gene Expression Regulation, Neoplastic
- Gene Rearrangement
- Genotype
- Heart Atria/pathology
- Heart Neoplasms/diagnosis
- Heart Neoplasms/drug therapy
- Heart Neoplasms/genetics
- Heart Neoplasms/immunology
- Heart Neoplasms/pathology
- Heart Ventricles/pathology
- Humans
- Immunophenotyping
- Karyotyping
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Middle Aged
- Pericardium/pathology
- Prednisone/administration & dosage
- Prednisone/therapeutic use
- Treatment Outcome
- Vincristine/administration & dosage
- Vincristine/therapeutic use
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Affiliation(s)
- Alessandra F Nascimento
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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16
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Aqel RA, Hage FG, Cogar B, Burri M, Wells B, Allison S, Zoghbi GJ, Perry G, Bittner V, Fan P, Nanda NC. Transthoracic Echocardiography Guided Procedures in the Catheterization Laboratory. Echocardiography 2007; 24:1000-7. [PMID: 17894583 DOI: 10.1111/j.1540-8175.2007.00497.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Raed A Aqel
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1530 3rd Avenue S., Birmingham, AL 35294, USA.
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17
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Abramowitz Y, Hiller N, Perlman G, Admon D, Beeri R, Chajek-Shaul T, Leibowitz D. The diagnosis of primary cardiac lymphoma by right heart catheterization and biopsy using fluoroscopic and transthoracic echocardiographic guidance. Int J Cardiol 2007; 118:e39-40. [PMID: 17383751 DOI: 10.1016/j.ijcard.2006.12.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Revised: 11/29/2006] [Accepted: 12/30/2006] [Indexed: 11/17/2022]
Abstract
We describe a case of primary cardiac lymphoma diagnosed by transvenous biopsy under fluoroscopic and transthoracic echocardiographic guidance. A 38-year-old man was admitted because of exertional dyspnea. ECG revealed complete atrioventricular block. Transthoracic echocardiography revealed a large mass attached to the interventricular septum and protruding into the right atrium. The patient underwent a right heart catheterization and a biopsy was taken from the mass using fluoroscopic and transthoracic echocardiographic guidance. Diagnosis of malignant lymphoma was established by the biopsy specimen. The use of transthoracic echo in conjunction with fluoroscopy may be useful for the diagnosis of intracardiac mass transvenously.
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18
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Aqel R, Dobbs J, Lau Y, Lloyd S, Gupta H, Zoghbi GJ. Transjugular biopsy of a right atrial mass under intracardiac echocardiographic guidance. J Am Soc Echocardiogr 2006; 19:1072.e5-8. [PMID: 16880106 DOI: 10.1016/j.echo.2006.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Indexed: 11/24/2022]
Abstract
Biopsy of cardiac tumors to obtain a tissue diagnosis has been performed under echocardiographic (transthoracic or transesophageal) or fluoroscopic guidance. We report successful transjugular biopsy of a right atrial mass using intracardiac echocardiographic guidance.
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Affiliation(s)
- Raed Aqel
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama 35294-0007, USA
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19
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Coronary artery encasement by metastatic cardiac lymphoma: Multidetector CT and MR imaging findings. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.ejrex.2005.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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20
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Yamagami T, Kato T, Tanaka O, Hirota T, Ito K, Nishimura M, Shimada J, Nishiyama K, Nishimura T. Percutaneous needle biopsy under CT fluoroscopic guidance for cardiac tumor during continuous intravenous injection of contrast material. J Vasc Interv Radiol 2005; 16:559-61. [PMID: 15802460 DOI: 10.1097/01.rvi.0000150924.10446.d2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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21
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Takenaka S, Mitsudo K, Inoue K, Goto T, Kadota K, Fujii S, Yamamoto H, Fuku Y, Hirono A, Tanaka H, Taba M, Ikeda A, Kojima Y, Maekawa J, Maekawa S, Takahashi N, Saeki H, Nakamura Y, Oonishi T, Ueda N. Successful Treatment of Primary Cardiac Lymphoma With Atrioventricular Nodal Block. Int Heart J 2005; 46:927-31. [PMID: 16272785 DOI: 10.1536/ihj.46.927] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 69-year-old female suffering from third-degree atrioventricular block with syncope underwent permanent pacemaker implantation. However, she developed shortness of breath 2 months after the implantation. Blood tests revealed elevated levels of LDH, CRP, BNP, and SIL-2R. Transthoracic echocardiography showed thickened left and right atrial walls with mild pericardial effusion. A diagnosis was made based on a CT scan and histology. Although most primary cardiac malignant lymphomas are associated with a poor prognosis, the patient was treated successfully with chemotherapy.
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Affiliation(s)
- Sou Takenaka
- Department of Cardiology, Kurashiki Central Hospital, Miwa, Okayama, Japan
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22
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Ikeda H, Nakamura S, Nishimaki H, Masuda K, Takeo T, Kasai K, Ohashi T, Sakamoto N, Wakida Y, Itoh G. Primary lymphoma of the heart: case report and literature review. Pathol Int 2004; 54:187-95. [PMID: 14989742 DOI: 10.1111/j.1440-1827.2003.01606.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary cardiac lymphoma (PCL) is a rare and usually fatal neoplasma. A case of PCL in a 78-year-old man who complained of exertional dyspnea and peripheral edema is presented. Echocardiography revealed a mass in the right atrium and a diagnosis of low-grade B-cell lymphoma was obtained with the surgically resected tumor. The lesion appeared to have originated in the right atrium and involved the right ventricle. The patient died of bronchopneumonia 8 months after the initial consultation. The present case and 39 patients with PCL reported between 1995 and 2002 were reviewed. Forty patients showed various and non-specific symptoms such as dyspnea, edema, arrhythmia and pericardial effusion. Primary cardiac lymphoma occurred slightly more often in male patients (M : F = 23:17) and in the elderly in general (mean age, 67 years), with lesions found in the following locations, listed in order of frequency: right atrium, pericardium, right ventricle, left atrium, left ventricle, and other sites. Antemortem diagnosis was obtained in 37 of the 40 patients. Thirty-seven cases were of B-cell lineage and two cases were of T-cell lineage. Complete remission was obtained in only 15 of the 40 patients. Although PCL antemortem diagnoses have been made in the majority of recent cases, the prognosis still remains poor.
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Affiliation(s)
- Hiroshi Ikeda
- First Department of Pathology, Aichi Medical University, Aichi, Japan.
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23
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Meshref M, Sassolas F, Schell M, Chalabreysse L, Chassagne C, Mialou V, Marec Bérard P, Di Filippo S, Bergeron C. Primary cardiac Burkitt lymphoma in a child. Pediatr Blood Cancer 2004; 42:380-3. [PMID: 14966837 DOI: 10.1002/pbc.20005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Primary cardiac lymphoma (PCL) is a rare and usually fatal malignancy, seldom reported in children. This report describes the case of a 10-year-old boy who presented with multiple intracardiac masses which, when biopsied, proved to be small non-cleaved cell (Burkitt's) lymphoma. The first two cycles of chemotherapy according to the LMB 96 protocol were given under close cardiological supervision, with good response. The treatment was then continued with full-dose chemotherapy, without any cardiological complication. The patient who was treated by chemotherapy alone remains in complete remission 36 months after the end of treatment and can presently be considered as cured, without late cardiac effect.
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24
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Abstract
Primary cardiac lymphoma is a very rare malignancy, which is typically of a non-Hodgkin type, and involves only the heart and pericardium with no or minimal evidence of extracardiac involvement. Primary cardiac lymphoma account for about 1% of the primary cardiac tumors and 0.5% of the extranodal lymphomas. On the other hand, disseminated lymphoma with cardiac involvement can occur in up to 20% of patients with lymphoma. About 80% of cases of the primary cardiac lymphoma in immunocompetent hosts are of diffuse B-cell lymphoma, and in patients with immunodeficiency states, small noncleaved or immunoblastic lymphomas are more frequent. The right atrium and right ventricle are the 2 most frequently involved sites. Clinical presentation is heterogeneous and is generally related to the site of involvement in the heart. The diagnosis is suspected when patients present with a cardiac mass or an unexplained refractory pericardial effusion. A thorough workup should include transthoracic and transesophageal echocardiography, computed tomography, and magnetic resonance imaging. Diagnosis is confirmed by cytology of the serous fluid from pericardial or pleural effusion or biopsy of the pericardial mass or endomyocardial tissue. The exploratory thoracotomy should not be delayed if indicated. Chemotherapy has been used alone or combined with radiotherapy. Similarly, palliative cardiac surgery has been performed, mainly for tumor debulking. Combination of chemotherapy and radiation therapy is considered as the treatment of choice. The survival is generally less than a month without treatment but has been prolonged up to 5 years with palliative treatments in selected cases.
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Affiliation(s)
- Ramesh M Gowda
- Division of Cardiology, Long Island College Hospital, Brooklyn, NY, USA
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25
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Flox Camacho A, Hernández Hernández F, Salguero Bodes R, Sánchez Pérez I, Carbonell Porras A, Tascón Pérez J. Linfoma cardíaco primario: diagnóstico mediante biopsia transyugular. Rev Esp Cardiol 2003; 56:1141-4. [PMID: 14622547 DOI: 10.1016/s0300-8932(03)77026-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Primary cardiac lymphoma, defined as a non-Hodgkin's lymphoma involving only the heart and pericardium, is an extremely rare malignancy. It should be suspected in patients with a heart mass and heart failure, unexplained refractory pericardial effusion or rhythm disturbances. Transvenous intracardiac tumor biopsy under fluoroscopic or transesophageal echocardiographic guidance, is a minimally invasive technique which makes definite diagnosis possible. We describe a patient in whom primary cardiac lymphoma was diagnosed by this technique. He also underwent percutaneous balloon pericardiotomy because of severe refractory pericardial effusion. Seven months after diagnosis and treatment with standard chemotherapy, the patient remained free of disease.
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Affiliation(s)
- Angela Flox Camacho
- Unidad de Hemodinámica y Cardiología Intervencionista. Hospital 12 de Octubre. Madrid. Spain.
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26
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Rolla G, Bertero MT, Pastena G, Tartaglia N, Corradi F, Casabona R, Motta M, Caligaris-Cappio F. Primary lymphoma of the heart. A case report and review of the literature. Leuk Res 2002; 26:117-20. [PMID: 11734310 DOI: 10.1016/s0145-2126(01)00092-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Primary cardiac lymphoma (PCL) is a rare and usually fatal neoplasm, which may cause syncope, arrhythmia, heart failure and pericardial effusion as presenting clinical complaints. A case of PCL in a 72-year-old man with moderate aortic stenosis is presented. The patient was investigated because of pericardial effusion and diagnosis of diffuse large B-cell lymphoma was obtained by open-chest biopsy of the heart. Fatal ventricular arrhythmia developed the day after the first course of chemotherapy. Clinical presentations and diagnostic approach of this rare tumour are discussed. While chemotherapy is the only effective treatment of PCL, early post-chemotherapy phase should be considered critical in patients with PCL, as suggested by other reported fatal complications in this period.
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Affiliation(s)
- Giovanni Rolla
- Department of Biomedical Sciences and Human Oncology, Clinical Immunology and Haematology Division, Ospedale Mauriziano Umberto I di Torino, University of Torino, Largo Turati 62, 10128, Torino, Italy.
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