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Kudo H, Shiroshita K, Shiozawa Y, Fujita S, Sakamoto M, Nakamura N, Nakanishi K, Toyama T. Autopsy case of cardiac mantle cell lymphoma presenting with recurrent pulmonary tumor embolism after chemotherapy. J Clin Exp Hematop 2024; 64:242-251. [PMID: 39085128 DOI: 10.3960/jslrt.24024] [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] [Indexed: 08/02/2024] Open
Abstract
A 78-year-old Japanese man presented to the emergency department with a sore throat and fever that worsened over 3 weeks. A tonsil biopsy led to the diagnosis of pleomorphic mantle cell lymphoma (MCL) that had infiltrated the right adrenal gland, inferior vena cava, and right atrium (RA). Although the patient's cardiac tumor had high mobility, his hemodynamic state was stable, and he did not present with fatal arrhythmia. Therefore, we first introduced chemotherapy. However, the patient developed recurrent pulmonary embolisms (PEs) and died after starting chemotherapy. An autopsy revealed that the MCL had invaded the large vessels, causing the PEs. Although the high mobility of cardiac tumors is known to increase the risk of PE in diffuse large B-cell lymphoma (DLBCL), optimal management of cardiac MCL remains to be elucidated owing to its rarity. To the best of our knowledge, this is the first report of cardiac MCL with posttreatment PE development in a Japanese patient. It is worth considering preventive surgery before treatment not only in DLBCL, but also in MCL based on the mobility of the cardiac tumors. Our case highlights the need for close communication between hematologists and cardiologists to treat cardiac MCL.
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Affiliation(s)
- Himari Kudo
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Tachikawa Hospital, Tokyo, Japan
| | - Kohei Shiroshita
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Tachikawa Hospital, Tokyo, Japan
| | - Yuka Shiozawa
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Tachikawa Hospital, Tokyo, Japan
| | - Shinya Fujita
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Tachikawa Hospital, Tokyo, Japan
| | - Miki Sakamoto
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Tachikawa Hospital, Tokyo, Japan
| | - Naoya Nakamura
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
| | - Kuniaki Nakanishi
- Department of Pathology, Federation of National Public Service Personnel Mutual Aid Associations Tachikawa Hospital, Tokyo, Japan
| | - Takaaki Toyama
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Tachikawa Hospital, Tokyo, Japan
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Trung Nguyen K, Van Dang B, Thai Pham D, Viet Tran T, Dinh Le T, Tien Nguyen S, Minh Vu D, Tien Le D, Van Nguyen B, Anh Vu H, Manh Do H, Quang Nguyen H, Ba Ta T, Huy Duong H, Pham Vu Thu H, Duy Nguyen T, Hong Le T, Van Ngo D, Dinh HT, Luong Cong T. Patient With a Diffuse Large B-Cell Non-Hodgkin Lymphoma in the Right Heart Chamber That Caused Cardiogenic Shock Was Well-Responded to Corticosteroids and Chemotherapy. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241277663. [PMID: 39282244 PMCID: PMC11401011 DOI: 10.1177/11795476241277663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 08/08/2024] [Indexed: 09/18/2024]
Abstract
Heart tumors are sporadic. Secondary heart tumors are 30 times more common than primary ones. Depending on the location and origin of the tumor, clinical pictures vary from asymptomatic to severe manifestations such as arrhythmia, heart failure, pericardial effusion, and cardiogenic shock. We report hereby a rare case who presented with faint clinical symptoms, rapidly progressing to right heart failure within a month. Echocardiography and computed tomography of the chest revealed a tumor in the right heart chamber of 72.0 × 43.0 mm, in addition to large mediastinal lymph and left supraclavicular lymph nodes, cardiogenic shock appeared 4 days after admission. Through examination, it was suspected that this was a cardiac lymphoma. The patient was treated with 2 mg methylprednisolone per kg body weight. Symptoms of cardiogenic shock improved significantly and disappeared after 6 hours of treatment. After supraclavicular lymph node biopsy and immunohistochemistry, the final result was diagnosed as diffuse large B-cell non-Hodgkin lymphoma with large lymphoma in the right heart. The patient received chemotherapy with the R-CHOP regimen (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone). Re-examination before the 5th chemotherapy cycle showed no signs of right heart failure, normal self-activity, and no dyspnea on exertion, and the tumor size in the heart on the echocardiogram was 23.8 × 19.1 mm. The report shows that a large right heart tumor with a clinical picture of cardiogenic shock in a patient with diffuse large B-cell non-Hodgkin's lymphoma was well-responded to initial treatment with methylprednisolone at a dose of 2 mg/kg body weight and R-CHOP chemotherapy.
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Affiliation(s)
- Kien Trung Nguyen
- Center of Emergency, Critical Care Medicine and Clinical Toxicology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Ba Van Dang
- Center of Emergency, Critical Care Medicine and Clinical Toxicology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Dung Thai Pham
- Center of Emergency, Critical Care Medicine and Clinical Toxicology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Tien Viet Tran
- Department of Infectious Diseases, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Tuan Dinh Le
- Department of Rheumatology and Endocrinology, Military Hospital 103, Vietnam Medical Military University, Hanoi, Vietnam
| | - Son Tien Nguyen
- Department of Rheumatology and Endocrinology, Military Hospital 103, Vietnam Medical Military University, Hanoi, Vietnam
| | - Duong Minh Vu
- Center of Emergency, Critical Care Medicine and Clinical Toxicology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Dung Tien Le
- Center of Emergency, Critical Care Medicine and Clinical Toxicology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Bang Van Nguyen
- Department of Clinical Hematology - Toxicology - Radiation and Occupational Diseases, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Hai Anh Vu
- Department of Thoracic Surgery, Military Hospital 103, Vietnam Medical Military University, Hanoi, Vietnam
| | - Hung Manh Do
- Center of Emergency, Critical Care Medicine and Clinical Toxicology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Huy Quang Nguyen
- Center of Emergency, Critical Care Medicine and Clinical Toxicology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Thang Ba Ta
- Respiratory Center, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Hoang Huy Duong
- Department of Neurology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Ha Pham Vu Thu
- Cardiovascular Center, Military Hospital 103, Vietnam Medical Military University, Hanoi, Vietnam
| | - Toan Duy Nguyen
- Cardiovascular Center, Military Hospital 103, Vietnam Medical Military University, Hanoi, Vietnam
| | | | - Dan Van Ngo
- Department of Nuclear Medicine, Center for Diagnostic Imaging, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Hoa Trung Dinh
- Departmen of Requested Treatment, National Hospital of Endocrinology, Hanoi, Vietnam
| | - Thuc Luong Cong
- Cardiovascular Center, Military Hospital 103, Vietnam Medical Military University, Hanoi, Vietnam
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Sabzwari SRA, Tzou WS. Systemic Diseases and Heart Block. Rheum Dis Clin North Am 2024; 50:381-408. [PMID: 38942576 DOI: 10.1016/j.rdc.2024.03.008] [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] [Indexed: 06/30/2024]
Abstract
Systemic diseases can cause heart block owing to the involvement of the myocardium and thereby the conduction system. Younger patients (<60) with heart block should be evaluated for an underlying systemic disease. These disorders are classified into infiltrative, rheumatologic, endocrine, and hereditary neuromuscular degenerative diseases. Cardiac amyloidosis owing to amyloid fibrils and cardiac sarcoidosis owing to noncaseating granulomas can infiltrate the conduction system leading to heart block. Accelerated atherosclerosis, vasculitis, myocarditis, and interstitial inflammation contribute to heart block in rheumatologic disorders. Myotonic, Becker, and Duchenne muscular dystrophies are neuromuscular diseases involving the myocardium skeletal muscles and can cause heart block.
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Affiliation(s)
- Syed Rafay A Sabzwari
- University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Mail Stop B130, Aurora, CO 80045, USA
| | - Wendy S Tzou
- Cardiac Electrophysiology, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue, MS B-136, Aurora, CO 80045, USA.
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Ke C, Chen M, Huang Y, Chen Y, Lin C, Huang P. Cardiac toxicity of brentuximab vedotin: a real-word disproportionality analysis of the FDA Adverse Event Reporting System (FAERS) database. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:5253-5264. [PMID: 38270617 DOI: 10.1007/s00210-024-02955-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
Brentuximab vedotin (BV) has obtained approval for the therapeutic management of classical Hodgkin lymphoma as well as systemic anaplastic large cell lymphoma. Given the inherent constraints of conventional clinical trials, the correlation between BV and cardiac adverse events (AEs) remains enigmatic. The objective of this investigation is to comprehensively assess cardiac AEs attributed to BV by employing advanced data mining techniques, utilizing the FDA Adverse Event Reporting System (FAERS). The indices for the assessment of disproportionality encompass the reporting odds ratio (ROR), the proportional reporting ratio, the information component, and the empirical Bayesian geometric mean. Employing these sophisticated metrics, we gauged the extent of disproportionate occurrences. The dataset was sourced from the FAERS from the first quarter of 2012 to first quarter of 2023, facilitating a comprehensive analysis of the potential correlation between BV and cardiac AEs. This scrutiny encompassed a comparative analysis of both cardiac and non-cardiac AEs. A total of 495 cases of BV's cardiac AEs were discerned, with the identification of 31 preferred terms (PTs). Among these, 8 PTs emerged as conspicuous signals of cardiac AEs, notably encompassing ventricular hypokinesia (ROR 7.59), tachyarrhythmia (ROR 7.06), sinus tachycardia (ROR 6.18), cardiopulmonary failure (ROR 4.44), pericardial effusion (ROR 4.32), acute coronary syndrome (ROR 4.02), cardiomyopathy (ROR 3.30), and tachycardia (ROR 2.76). The manifestation of severe outcomes demonstrates a discernible correlation with the cardiac AEs (P < 0.001). Our investigation furnishes invaluable insights for healthcare practitioners to proactively mitigate the incidence of BV-associated cardiac AEs.
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Affiliation(s)
- Chengjie Ke
- Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
- Department of Pharmacy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Maohua Chen
- Department of Pharmacy, Pingtan Comprehensive Experimental Area Hospital, Pingtan Comprehensive Experimental Area, Fuzhou, 350400, China
| | - Yaping Huang
- Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350005, China
| | - Yan Chen
- Department of Pharmacy, Pingtan Comprehensive Experimental Area Hospital, Pingtan Comprehensive Experimental Area, Fuzhou, 350400, China
| | - Cuihong Lin
- Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.
- Department of Pharmacy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
| | - Pinfang Huang
- Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.
- Department of Pharmacy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
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Alattar K, Dodhia S, Huang CY, Neves JB, Haris A. Intracardiac diffuse large B-cell lymphoma: an unexpected diagnosis. BMJ Case Rep 2024; 17:e259242. [PMID: 38914528 DOI: 10.1136/bcr-2023-259242] [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] [Indexed: 06/26/2024] Open
Abstract
Intracardiac lymphomas are exceedingly rare accounting for only 1% of all primary cardiac tumours. Historically, due to their insidious development and non-specific clinical presentation, the diagnosis has been challenging with most cases being confirmed on post-mortem examination. Our case report details the experience of a previously fit and active woman in her 60s who presented with gradual onset exertional dyspnoea. Through a series of multimodal imaging tools (including echocardiogram, cardiac MRI, CT and positron emission tomography-CT) and biopsy, we confirmed the diagnosis of intracardiac diffuse large B-cell lymphoma. Our patient was managed with chemotherapy and went on to demonstrate excellent radiological response with near-complete resolution of the intracardiac mass. Subjectively, our patient reported significant improvement in exercise tolerance within weeks of commencing treatment.
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MESH Headings
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/pathology
- Female
- Heart Neoplasms/diagnostic imaging
- Heart Neoplasms/drug therapy
- Middle Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Echocardiography
- Dyspnea/etiology
- Magnetic Resonance Imaging
- Tomography, X-Ray Computed
- Cyclophosphamide/therapeutic use
- Positron Emission Tomography Computed Tomography
- Diagnosis, Differential
- Doxorubicin/therapeutic use
- Biopsy
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Khurshid A, Okezue C, Frishman WH, Aronow WS. Cardiac Manifestations of Lymphoma: A Review of Primary and Secondary Cardiac Lymphoma. Cardiol Rev 2024:00045415-990000000-00283. [PMID: 38814100 DOI: 10.1097/crd.0000000000000736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Primary cardiac lymphoma (PCL) is a very unique and uncommon disease presentation, with reports in the literature limited to case reports. Most often it is B-cell in origin, predominantly diffuse large B-cell lymphoma. Symptomatic presentation of PCL depends on the location of anatomic involvement, but most often involves the right heart, with presentation consistent with heart failure, pericardial effusions, and atrioventricular nodal blockade. Endomyocardial biopsy is necessary for diagnosis, but cardiac magnetic resonance imaging has been the most useful for staging of the disease. The disease has a poor prognosis but treatment with chemotherapy has been the most successful approach. Particularly, the chemotherapy regimen of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone has been reported to be successful for diffuse large B-cell lymphoma, so it is often utilized first. In newer reports of patients with PCL, there may be a role of autologous stem cell transplant along with consolidative chemotherapy in younger patients diagnosed with PCL. Secondary cardiac lymphoma (SCL) is a more common occurrence that is often asymptomatic and recognized after the patient has passed from either the primary lymphoma or some other reason. Unlike PCL, SCL is more expansive and not often confined to the right heart. However, in patients with SCL who do have cardiac symptoms, the diagnostic approach and treatment are similar to that of PCL.
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Affiliation(s)
- Aatif Khurshid
- From the Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Chisom Okezue
- From the Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - William H Frishman
- From the Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
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Nasir A, Patel YB. Diffuse Large B-cell Lymphoma Presenting as a Cardiac Mass. Cureus 2024; 16:e59755. [PMID: 38840985 PMCID: PMC11152600 DOI: 10.7759/cureus.59755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/07/2024] Open
Abstract
Cardiac involvement as the initial presentation of lymphoma is a rare occurrence. The most common type of cardiac lymphoma is diffuse large B-cell lymphoma (DLBCL), which often affects the right atrium. Cardiac lymphoma can either be mediastinal DLBCL invading the heart or primary cardiac lymphoma. We describe the case of an 84-year-old female who presented with an eight-week history of dyspnea. Computed tomography angiography (CTA) of the chest showed a right-sided pleural effusion with collapse of the right middle and lower lobes as well as a large mass-like density within the anterior pericardium, compressing the right atrium and right ventricle and encasing the right coronary artery. A transthoracic echocardiogram (TTE) showed a multilocular hypoechoic mass in the right atrium with invasion into the wall of the right atrium. The patient underwent diagnostic and therapeutic thoracentesis. Pleural fluid cytology revealed diffuse large B-cell lymphoma, with positive stains for CD20, PAX5, CD10, BCL6, and Mum-1. Fluorescence in situ hybridization (FISH) revealed an abnormality of BCL2/18q (16%). A staging positron emission tomography (PET) scan showed a large mediastinal mass involving the right pericardium, focal uptake in the left thyroid lobe, left skull base, and musculature around the proximal left femur. Chemotherapy was initiated with R-mini-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). PET scans after three cycles of chemotherapy showed a complete metabolic response with the resolution of previously noted hypermetabolic lesions. The patient completed all six cycles of chemotherapy without issues. The differential diagnosis of a right atrial cardiac mass should include lymphoma. TTE is usually the initial imaging test, and a tissue biopsy is required for a definitive diagnosis. DLBCL is highly aggressive and carries a poor prognosis if untreated. Early diagnosis and treatment with standard chemotherapy are crucial for favorable outcomes.
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Affiliation(s)
- Abdullah Nasir
- Internal Medicine, Trinity Health Ann Arbor Hospital, Ann Arbor, USA
| | - Yash B Patel
- Internal Medicine, Trinity Health Ann Arbor Hospital, Ann Arbor, USA
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Ebina T, Sano Y, Hirabayashi M, Tsurumi T, Watanabe M, Furukawa M, Matsuo W, Nagasawa H, Hirose H, Horii M, Nakajima Y, Fujisawa S, Iwahashi N, Hibi K. Echocardiographic Findings of Malignant Lymphoma with Cardiac Involvement: A Single-center Retrospective Observational Study. Intern Med 2024; 63:359-364. [PMID: 37258159 PMCID: PMC10901707 DOI: 10.2169/internalmedicine.1902-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/18/2023] [Indexed: 06/02/2023] Open
Abstract
Objective Although malignant lymphoma (ML) can occur in every organ, diagnosing cardiac involvement without cardiac manifestations is difficult. We therefore investigated the incidence of cardiac involvement in ML in our hospital and clarified the transthoracic echocardiography (TTE) findings of cardiac involvement. Methods Patients with ML referred to our hospital between January 2013 and December 2019 were retrospectively reviewed. Patients During the study period, 453 patients were identified. The mean age was 64.9 years old, and 54% of the patients were men. Results Diffuse large B-cell lymphoma (DLBCL) was the most common lymphoma, followed by follicular lymphoma. Of the 453 patients, 394 (87.0%) underwent TTE at the initial diagnosis or during the clinical course. The performance rates of TTE in DLBCL, Hodgkin lymphoma, and mantle cell lymphoma were above 90%. Cardiac involvement was detected in 6 (five with DLBCL and one with B-cell lymphoma) (1.5%) of the 394 patients who underwent TTE. The involved lesions of the heart varied, and five patients had pericardial effusion. Five patients had a preserved left ventricular ejection fraction. All patients were treated with chemotherapy, and some were treated with radiation and surgery. Conclusion Cardiac involvement was observed in six (1.5%) of the patients with ML who underwent TTE. B-cell lymphoma, especially DLBCL, is a common ML with cardiac involvement. Although five patients had pericardial effusion, the involved lesions of the heart were not uniform. TTE is a useful imaging modality to noninvasively and repeatedly evaluate the tumor characteristics, response to ML treatment, and cardiac function.
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Affiliation(s)
- Toshiaki Ebina
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Japan
| | - Yuka Sano
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Japan
| | - Michiko Hirabayashi
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Japan
| | - Tomomi Tsurumi
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Japan
| | - Mika Watanabe
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Japan
| | - Mio Furukawa
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Japan
| | - Wakana Matsuo
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Japan
| | - Hazuki Nagasawa
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Japan
| | - Haruka Hirose
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Japan
| | - Mutsuo Horii
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Japan
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Yuki Nakajima
- Department of Hematology, Yokohama City University Medical Center, Japan
| | - Shin Fujisawa
- Department of Hematology, Yokohama City University Medical Center, Japan
| | - Noriaki Iwahashi
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Japan
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Chauhan A, Mudey A, Singh H. MRI and CT Appearances in Various Cardiac Tumours. Cureus 2024; 16:e51488. [PMID: 38304651 PMCID: PMC10831205 DOI: 10.7759/cureus.51488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/26/2023] [Indexed: 02/03/2024] Open
Abstract
While primary cardiac malignancies are infrequent, the heart often serves as a site for metastases. Myxomas are recognized as among the most prevalent primary benign tumours globally, while sarcomas represent the most common malignant primary tumours. The diverse range of potential clinical presentations depends on factors such as location, size, and the aggressiveness of the disease. The majority of diagnoses rely on medical imaging, making it crucial to familiarize oneself with their distinctive characteristics. When a cardiac mass is suspected, MRI of the heart has emerged as the preferred diagnostic method, surpassing previous techniques. CT is a valuable tool for assessing cardiac morphology and improving electrocardiography gating by providing enhanced details. This article conducts a comprehensive review of the MRI and CT characteristics of both primary and secondary cardiac malignancies, emphasizing crucial distinctions and common diagnostic pitfalls. Despite their rarity, cardiac masses continue to hold significance in the realm of cardio-oncology. Furthermore, this article explores conditions such as thrombus, Lambl's excrescences, and pericardial cysts, which can mimic tumours. Multimodal imaging has played a pivotal role in identifying the origin of cardiac masses in numerous cases, particularly when combined with the clinical context. This article offers an in-depth examination of the frequency, clinical indicators, imaging, diagnostic procedures, available treatments, and prognoses related to cardiac masses.
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Affiliation(s)
- Aayush Chauhan
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhay Mudey
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshit Singh
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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10
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Chen X, Chen Y, Xiao F, Liu M, Gu Z, Li Y, Hong M. Survival and analysis of prognostic factors for primary malignant cardiac tumors based on the SEER database. J Cancer Res Clin Oncol 2023; 149:15687-15696. [PMID: 37665405 DOI: 10.1007/s00432-023-05351-4] [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] [Received: 07/27/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The purpose of this study was to use the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the survival rate of primary malignant cardiac tumors (PMCTs), assess the risk factors affecting survival, and calculate the number of PMCT cases in recent years. METHODS SEER 22 registries were used to calculate the number of cases PMCT. Data on age, sex, race, marital status, tumor size, the American Joint Committee on Cancer (AJCC) stage, lymph node involvement, metastasis, treatment, and survival were collected to analyze the survival and prognostic factors of SEER 17 registries. Using the Kaplan-Meier estimation method, a survival curve was obtained according to the influencing factors, and a multivariable Cox regression model was established. RESULTS In recent years, the average annual number of PMCT cases was 20.56 ± 7.12, significantly higher than the average before 2004 (P = 0.015; 95% CI 1.14-8.98). The 1-, 3-, and 5-year survival rates were 45.6%, 18.8%, and 11.2%, respectively. Multivariate analysis revealed that age (risk ratio [HR], 2.047; 95% CI 1.381-3.034), AJCC stage III (HR, 1.786; 95% CI 1.123-2.839), AJCC staging with distant metastasis (HR, 2.666; 95% CI 1.509-4.709), no chemotherapy (HR, 2.011; 95% CI 1.561-2.590), and tumor size larger than 99 mm (HR, 1.766; 95% CI 1.132-2.756) were independent risk factors for poor prognosis. Only age over 76 years and distant metastasis were independent risk factors for prognosis in the chemotherapy group. CONCLUSION In recent years, the annual number of patients with PMCT has increased significantly. Due to developments in chemotherapy, we should re-evaluate the traditional tumor staging and prognostic risk indicators to improve clinical applications.
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Affiliation(s)
- Xiaoxiao Chen
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Yizhou Chen
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Fangping Xiao
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Meng Liu
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Zhan Gu
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Yi Li
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Mei Hong
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China.
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Ishibashi Y, Zhang S, Tamura S, Ishii H. Brugada phenocopy with altered ST-segment elevation in pericardial diffuse large B-cell lymphoma and effusive-constrictive pericarditis: a case report. Eur Heart J Case Rep 2023; 7:ytad463. [PMID: 37854103 PMCID: PMC10580269 DOI: 10.1093/ehjcr/ytad463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/26/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023]
Abstract
Background Cardiac lymphoma is a rare disease. Effusive-constrictive pericarditis can be a characteristic of pericardial involvement in patients with this disease. Conversely, a phenotype with electrocardiogram changes similar to those of Brugada syndrome is called Brugada phenocopy, and these changes improve after treatment. Case summary A 71-year-old man was transported to our hospital with chest pain, hypotension, and ST-segment elevation in V1 and V2 leads during maintenance dialysis for renal failure. After arrival at the hospital, his ST-segment elevation disappeared, and emergency coronary angiography scan revealed no significant coronary artery stenoses or obstructions. His computed tomography and echocardiography scans revealed pericardial effusion and an intrapericardial mass. Further, his blood pressure dropped and ST-segment elevation recurred during dialysis after 7 days. Thus, pericardiocentesis was performed, but haemodynamic improvement was insufficient, and right catheterization findings suggested effusive-constrictive pericarditis. Meanwhile, flow cytometry of the pericardial fluid suggested the diagnosis of B-cell lymphoma; however, radical chemoradiotherapy was impossible because of cardiogenic shock. The patient died on Day 17. Further, autopsy revealed diffuse large B-cell lymphoma with pericardial and myocardial infiltration. Discussion Cardiac lymphoma is rare but can be associated with effusive-constrictive pericarditis, which may be difficult to manage even with pericardial drainage. In such cases, radical treatment, including chemotherapy, should be promptly considered, if possible. Our patient presented with Brugada-type electrocardiogram but no syncope or family history, suggesting Brugada phenocopy and not true Brugada syndrome due to cardiac lymphoma. Notably, temporary improvement in ST-segment elevation was observed despite the absence of treatment.
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Affiliation(s)
- Yohei Ishibashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-15, Showa Maebashi, Gunma 371-8511, Japan
- Department of Cardiology, National Hospital Organization Takasaki General Medical Center, 36, Takamatsu Takasaki, Gunma 370-0829, Japan
| | - Shanshan Zhang
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-15, Showa Maebashi, Gunma 371-8511, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-15, Showa Maebashi, Gunma 371-8511, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-15, Showa Maebashi, Gunma 371-8511, Japan
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12
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Kassab J, Gebrael G, Chedid El Helou M, El Dahdah J, Haroun E, Kassab R, Abou Ali S, Khabbaz Z, Kassab R. Case report: Primary cardiac lymphoma manifesting as superior vena cava syndrome. Front Cardiovasc Med 2023; 10:1257734. [PMID: 37808889 PMCID: PMC10556236 DOI: 10.3389/fcvm.2023.1257734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
A 64-year-old man presented with symptoms indicative of superior vena cava syndrome. Imaging work-up revealed an obstructing right atrial mass, which was subsequently excised and diagnosed as primary cardiac lymphoma. Post-surgery, the patient showed significant clinical improvement and was started on a chemotherapy regimen with complete remission at 1 year.
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Affiliation(s)
- Joseph Kassab
- Cleveland Clinic Foundation, Heart Vascular and Thoracic Institute, Cleveland, OH, United States
| | - Georges Gebrael
- Department of Medicine, Saint Joseph University of Beirut, Achrafieh, Beirut, Lebanon
| | - Michel Chedid El Helou
- Cleveland Clinic Foundation, Heart Vascular and Thoracic Institute, Cleveland, OH, United States
| | - Joseph El Dahdah
- Cleveland Clinic Foundation, Heart Vascular and Thoracic Institute, Cleveland, OH, United States
| | - Elio Haroun
- Cleveland Clinic Foundation, Heart Vascular and Thoracic Institute, Cleveland, OH, United States
| | - Rebecca Kassab
- Department of Medicine, Saint Joseph University of Beirut, Achrafieh, Beirut, Lebanon
| | - Saad Abou Ali
- Department of Cardiovascular Medicine, Sacre Coeur Hospital, Baabda, Beirut, Lebanon
| | - Ziad Khabbaz
- Department of Cardiovascular Medicine, Hotel-Dieu De France, Achrafieh, Beirut, Lebanon
| | - Roland Kassab
- Department of Cardiovascular Medicine, Hotel-Dieu De France, Achrafieh, Beirut, Lebanon
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13
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Sabzwari SRA, Tzou WS. Systemic Diseases and Heart Block. Cardiol Clin 2023; 41:429-448. [PMID: 37321693 DOI: 10.1016/j.ccl.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Systemic diseases can cause heart block owing to the involvement of the myocardium and thereby the conduction system. Younger patients (<60) with heart block should be evaluated for an underlying systemic disease. These disorders are classified into infiltrative, rheumatologic, endocrine, and hereditary neuromuscular degenerative diseases. Cardiac amyloidosis owing to amyloid fibrils and cardiac sarcoidosis owing to noncaseating granulomas can infiltrate the conduction system leading to heart block. Accelerated atherosclerosis, vasculitis, myocarditis, and interstitial inflammation contribute to heart block in rheumatologic disorders. Myotonic, Becker, and Duchenne muscular dystrophies are neuromuscular diseases involving the myocardium skeletal muscles and can cause heart block.
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Affiliation(s)
- Syed Rafay A Sabzwari
- University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Mail Stop B130, Aurora, CO 80045, USA
| | - Wendy S Tzou
- Cardiac Electrophysiology, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue, MS B-136, Aurora, CO 80045, USA.
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14
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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] [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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15
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Barradas MI, Duarte F, Rochate D, Pavão C, Tavares A, Dourado R, Martins D. Primary cardiac lymphoma: The unusual suspect and the importance of a multimodality approach. J Cardiol Cases 2023. [DOI: 10.1016/j.jccase.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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16
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Primary Cardiac Lymphoma in an 85-Year-Old Man, With Highly Suggestive Features on Imaging. CJC Open 2023; 5:167-169. [PMID: 36880075 PMCID: PMC9984892 DOI: 10.1016/j.cjco.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/29/2022] [Indexed: 12/09/2022] Open
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17
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Tandon R, Sachdeva S, Gupta R, Paul D. Primary Cardiac Lymphoma: Case Series. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2023. [DOI: 10.4103/jiae.jiae_49_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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18
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Ashry A, Tarmahomed A, Johns M, Samaddar A, Kutty R, Dhannapuneni R, Lotto A, Duong P, Guerrero R. Urgent Excision of Primary Intracardiac Burkitt Lymphoma in a Child. World J Pediatr Congenit Heart Surg 2023; 14:102-105. [PMID: 36274584 DOI: 10.1177/21501351221127288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 9-year-old girl presented with a recent history of shortness of breath, fatigue, visual disturbances, and gastrointestinal symptoms. Echocardiography demonstrated three large intracardiac masses in the right and left atria protruding into the mitral and tricuspid valve orifices causing bilateral inflow obstruction. She underwent urgent surgical excision of the masses. Histology revealed rare intracardiac Burkitt's Lymphoma.
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Affiliation(s)
- Amr Ashry
- Department of Paediatric Cardiac Surgery, 200462Alder Hey Children Hospital, Liverpool, UK
- Department of Cardiothoracic Surgery, 68797Faculty of Medicine, Assiut University Hospital, Assiut, Egypt
| | - Abdulla Tarmahomed
- Department of Paediatric Cardiology, 200462Alder Hey Children Hospital, Liverpool, UK
| | - Melonie Johns
- Department of Paediatric Cardiology, 200462Alder Hey Children Hospital, Liverpool, UK
| | - Avishek Samaddar
- Department of Paediatric Cardiac Surgery, 200462Alder Hey Children Hospital, Liverpool, UK
| | - Ramesh Kutty
- Department of Paediatric Cardiac Surgery, 200462Alder Hey Children Hospital, Liverpool, UK
| | - Ramana Dhannapuneni
- Department of Paediatric Cardiac Surgery, 200462Alder Hey Children Hospital, Liverpool, UK
| | - Attilio Lotto
- Department of Paediatric Cardiac Surgery, 200462Alder Hey Children Hospital, Liverpool, UK
- Faculty of Health, 4589Liverpool John Moores University, Liverpool, UK
| | - Phuoc Duong
- Department of Paediatric Cardiology, 200462Alder Hey Children Hospital, Liverpool, UK
| | - Rafael Guerrero
- Department of Paediatric Cardiac Surgery, 200462Alder Hey Children Hospital, Liverpool, UK
- School of Medicine, University of Liverpool, Liverpool, UK
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19
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Calabretta R, Hacker M. A PET-derived tumor expansion pattern to differentiate between primary cardiac lymphoma from primary cardiac sarcoma. J Nucl Cardiol 2022; 29:2878-2880. [PMID: 36417119 DOI: 10.1007/s12350-022-03097-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Raffaella Calabretta
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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20
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Carvalho RR, Sousa JA, Ribeiras R, Fernandes R, Haas A, Neves J, Andrade MJ. A Patent Foramen Ovale Grants Cardiac Output Over an Obstructive Primary Cardiac Lymphoma. JACC Case Rep 2022; 4:1353-1356. [PMID: 36299656 PMCID: PMC9588447 DOI: 10.1016/j.jaccas.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 11/05/2022]
Abstract
Primary cardiac lymphomas are extremely rare and involve mainly the pericardium. We present the case of a 77-year-old man with a germinal center diffuse large B-cell lymphoma causing severe right ventricular inflow obstruction. Clinical presentation of isolated dyspnea and severe desaturation and cyanosis were, otherwise, unexpected. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Rita Ribeiro Carvalho
- Cardiology Department, Centro Hospitalar de Leiria, Leiria, Portugal,Address for correspondence: Dr Rita José Ribeiro Carvalho, Rua Mário Cesariny, nº6, 1ºA, 1600-313 Lisbon, Portugal. @_carvalhorita_
| | - João Adriano Sousa
- Cardiology Department, Centro Hospitalar Lisboa Ocidental–Hospital Santa Cruz, Lisboa, Portugal
| | - Regina Ribeiras
- Cardiology Department, Hospital Central e Universitário da Madeira, Funchal, Portugal
| | - Raquel Fernandes
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Andrea Haas
- Cardiology Department, Hospital Central e Universitário da Madeira, Funchal, Portugal
| | - José Neves
- Cardiology Department, Hospital Central e Universitário da Madeira, Funchal, Portugal
| | - Maria João Andrade
- Cardiology Department, Hospital Central e Universitário da Madeira, Funchal, Portugal
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21
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Liu E, Huang J, Dong H, Chen Z, Liu C, Xie Q, Xu W, Wang S, Liu Z. Diagnostic challenges in primary cardiac lymphoma, the opportunity of 18F-FDG PET/CT integrated with contrast-enhanced CT. J Nucl Cardiol 2022; 29:2378-2389. [PMID: 34318397 DOI: 10.1007/s12350-021-02723-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The purpose of this study was to retrospectively evaluate the value of 18F-FDG PET/CT integrated with contrast-enhanced CT (CECT) in the differential diagnosis of primary cardiac lymphomas (PCLs) and primary cardiac angiosarcomas (PCAs). METHODS Clinical and imaging data of patients with PCLs and PCAs were collected. All patients underwent preoperative 18F-FDG PET/CT and thoracic CECT. The enhancement pattern and tumor morphology were analyzed using CECT images. The intensity- and volume-based PET parameters of cardiac lesions were analyzed. The performance characteristics of all parameters were assessed. RESULTS Nine patients with PCL and eight patients with PCA were analyzed. There were significant differences in SUVmax (t = 3.790, P = .002), SUVmean (t = 4.273, P = .001), metabolic tumor volume (U = 13.00, P = .027), tumor-to-liver ratio (U = 10.00, P = .011), and total lesion glycolysis (U = 4.0, P = .001) between PCLs and PC18As. There were significant differences in the enhancement pattern of tumors (P = .002) and tumor morphology (P = .015). The combination of F-FDG PET/CT and CECT improved the diagnostic accuracy, and the combination cutoff (SUVmean > 5.17) could reach 100%, but the difference was not statistically significant (P > .05). CONCLUSION The intensity- and volume-based PET parameters of PCL were significantly higher than those of PCA. The enhancement pattern and tumor morphology were also different. According to these characteristics, the two most common types of primary cardiac malignancies can be differentiated.
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Affiliation(s)
- Entao Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- WeiLun PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jia Huang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Room 201, 2/F, WeiLun Building of Guangdong Provincial People's Hospital, 106 Zhongshan ER Road, Guangzhou, 510080, China
| | - Haojian Dong
- Department of Cardiology, Vascular Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zerui Chen
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chao Liu
- Department of Pathology and Laboratory Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qiu Xie
- Division of Adult Echocardiography, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weiping Xu
- WeiLun PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shuxia Wang
- WeiLun PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zaiyi Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Room 201, 2/F, WeiLun Building of Guangdong Provincial People's Hospital, 106 Zhongshan ER Road, Guangzhou, 510080, China.
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22
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Umair M, Zimmerman SL, Fishman EK. Lymphoma with cardiac and renal involvement: Report of a case imaged by CT with cinematic rendering. Radiol Case Rep 2022; 17:2199-2202. [PMID: 35496744 PMCID: PMC9048039 DOI: 10.1016/j.radcr.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/29/2022] [Accepted: 02/01/2022] [Indexed: 11/03/2022] Open
Abstract
Myocardial lymphoma can be seen in the setting of primary or secondary involvement, more common in later. Both primary and secondary involvement is usually seen in the setting of diffuse large B cell lymphoma. We describe a case of a 47-year-old man in cardiogenic shock due to refractory ventricular tachycardia (VT) necessitating intubation, extracorporeal membrane oxygenation (ECMO) and an intra-aortic balloon pump with diffuse thickening of the left ventricular myocardium on CTA chest and subtle infiltrative ill-defined perirenal hypodensities with renal enlargement on CT of abdomen and pelvis. Post-processing with cinematic rendering clearly showed improved tissue contrast and/or differentiation with better demarcation of both the myocardial and renal lesions. A myocardial biopsy demonstrated diffuse large B-cell lymphoma (DLBCL). The patient was treated for ventricular tachyarrhythmias, cardiogenic shock, DCBCL, and numerous complications during 6-month long hospitalization with significant improvement of systolic function at discharge. Myocardial lymphoma is an uncommon cardiac malignancy with common CT imaging appearances of multiple circumscribed iso-attenuating masses or diffuse ill-defined infiltrative myocardial thickening. These findings are better assessed with cinematic rendering due to accentuated depth perception and photorealistic appearance of this post processing modality.
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23
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Berton L, Van Ballaer V, Ghekiere O, De Caluwé E. Primary cardiac diffuse large B-cell lymphoma presenting with cardiac tamponade: a case report. Eur Heart J Case Rep 2022; 6:ytac151. [PMID: 35528120 PMCID: PMC9071390 DOI: 10.1093/ehjcr/ytac151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/09/2021] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Primary cardiac tumours are extremely rare with an autopsy incidence of 0.05%. They can present with a variety of symptoms, including life-threatening arrhythmia and cardiac tamponade. In this case report, we focus on the diagnostic process and management of a primary cardiac lymphoma (PCL) presenting with cardiac tamponade. CASE SUMMARY We report on a 71-year-old male presenting with a large pericardial effusion, tamponade, and a mass in the right atrioventricular groove. Multimodality imaging was performed, including transthoracic echocardiography, computed tomography, magnetic resonance imaging, positron emission tomography, and computed tomography-guided transthoracic biopsy. The final diagnosis of a double-hit diffuse large-cell B-cell lymphoma was made, for which treatment consisting of a combination of chemotherapy and immunotherapy was initiated. Low-dose colchicine was also added to the treatment. DISCUSSION Primary cardiac lymphoma remains a very rare diagnosis and this case highlights the need for multimodality imaging and imaging-guided biopsy to differentiate cardiac masses. First-line treatment for PCL remains a combination of chemotherapy with immunotherapy, with the addition of low-dose colchicine to prevent recurrence of malignant pericardial effusion.
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Affiliation(s)
| | | | - Olivier Ghekiere
- Department of Radiology, Jessa Hospital, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Cardiology and Organ systems, Hasselt University, 3500 Hasselt, Belgium
| | - Eva De Caluwé
- Department of Cardiology, Sint-Trudo Hospital, 3800 Sint-Truiden, Belgium
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24
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Hu B, Zhao J, Liang X, Ren C, Li N, Liang C. A case of complete atrioventricular block associated with primary cardiac lymphoma reversed without cardiac pacemaker implantation. J Int Med Res 2022; 50:3000605221089780. [PMID: 35387513 PMCID: PMC9003660 DOI: 10.1177/03000605221089780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Primary cardiac lymphoma (PCL) is a rare malignant lymphoma that is characteristically confined to the heart and/or pericardium. Here, the case of a 70-year-old male patient with complete atrioventricular block (AVB) associated with PCL is presented. The patient had a 10-month history of palpitation and electrocardiogram (ECG) showed a complete AVB. Additionally, transthoracic echocardiography indicated pericardial effusion where atypical lymphoid cells were identified by pericardiocentesis. Subsequent mediastinal lymph node biopsy revealed non-germinal centre diffuse large B-cell lymphoma. Therefore, a diagnosis of PCL was confirmed. As the patient’s vital signs were stable, he was prescribed chemotherapy without pacemaker implantation. After chemotherapy, the patient achieved remission and dynamic ECG demonstrated no recurrence of AVB. The present case demonstrates that although PCL initially manifesting as complete AVB is rare, this possibility should not be ignored when a new AVB without definite aetiology is encountered. In addition, if the vital signs of the patient are stable, pacemaker implantation may be postponed until the treatment effect of chemotherapy has been assessed.
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Affiliation(s)
| | | | | | | | | | - Chun Liang
- Chun Liang, Department of Cardiology, Shanghai Changzheng Hospital, the Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Huangpu, Shanghai 200003, China. E-mail:
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25
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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] [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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26
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Papanastasiou L, Skarakis N, Vardaka M, Dimitriadi A, Lampropoulou P, Perpinia A, Vidalakis E, Choreftaki T, Marinakis T, Kounadi T, Vatalas IA, Michalis E. A very rare case of extranodal B-cell non-Hodgkin lymphoma presenting with adrenal and heart involvement. Leuk Res Rep 2022; 17:100318. [PMID: 35539018 PMCID: PMC9079230 DOI: 10.1016/j.lrr.2022.100318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/31/2022] [Accepted: 04/25/2022] [Indexed: 11/24/2022] Open
Abstract
We report an extremely rare case of extranodal B-cell NHL: DLBCL (diffuse large B-cell non-Hodgkin lymphoma), stage IVE, presenting with heart and bilateral adrenal involvement. On admission, adrenal and thorax imaging identified large bilateral adrenal masses and a 4.6 cm mass in the right atrium wall. An adrenal biopsy revealed the presence of a DLBCL, with triple expression of bcl2, bcl6, C-MYC(+70%). Following six cycles of systemic immunochemotherapy with R-DA-EPOCH, and high methotrexate dose for CNS prophylaxis a marked decrease of lymphoma infiltration was observed. The selection of the appropriate treatment modality can lead to profound response and improve patient's outcome.
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Parlow S, Cheung M, Verreault-Julien L, Wu KY, Berardi P, Nair V, Di Santo P, Jung RG, Mathew R, Hibbert B. An Unusual Case of Obstructive Shock. JACC Case Rep 2021; 3:1913-1917. [PMID: 34984352 PMCID: PMC8693255 DOI: 10.1016/j.jaccas.2021.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/20/2021] [Accepted: 10/29/2021] [Indexed: 11/18/2022]
Abstract
A 54-year-old man presented in profound obstructive shock. Investigations revealed a right atrial mass causing severe right ventricular inflow obstruction and compromised cardiac output. The patient was treated with emergency balloon catheter intervention to relieve the obstruction, with resulting hemodynamic stability. The pathology report later returned a positive result for diffuse large B-cell lymphoma. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Matthew Cheung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Louis Verreault-Julien
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kai Yi Wu
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Philip Berardi
- Department of Pathology and Laboratory Medicine, University of Ottawa and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Vidhya Nair
- Department of Pathology and Laboratory Medicine, University of Ottawa and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard G. Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Abstract
Systemic diseases can cause heart block owing to the involvement of the myocardium and thereby the conduction system. Younger patients (<60) with heart block should be evaluated for an underlying systemic disease. These disorders are classified into infiltrative, rheumatologic, endocrine, and hereditary neuromuscular degenerative diseases. Cardiac amyloidosis owing to amyloid fibrils and cardiac sarcoidosis owing to noncaseating granulomas can infiltrate the conduction system leading to heart block. Accelerated atherosclerosis, vasculitis, myocarditis, and interstitial inflammation contribute to heart block in rheumatologic disorders. Myotonic, Becker, and Duchenne muscular dystrophies are neuromuscular diseases involving the myocardium skeletal muscles and can cause heart block.
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Wei XJ, Yuan H, Khong PL, Zhang F, Liao PJ, Jiang XM, Huang L, Guo HG, Chen FL, Liu SC, Huang YY, Wang SX, Li WY. Primary cardiac lymphoma: the management and outcome of a single-centre cohort of 22 patients. Acta Oncol 2021; 60:1122-1129. [PMID: 34402368 DOI: 10.1080/0284186x.2021.1950923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The incidence of primary cardiac lymphoma (PCL) is increasing, but the optimal management approach remains unclear. We assessed the clinical characteristics of a single-centre cohort with the goal of determining the optimal management approach. The treatment outcomes and prognostic factors are reported. MATERIAL AND METHODS All PCL patients were diagnosed via biopsy guided by whole-body imaging (positron emission tomography/computed tomography [PET/CT] and/or contrast-enhanced CT]. Curative therapy involved either surgery or prephase steroids followed by definitive immunochemotherapy, depending on the histological type. The primary outcomes were overall survival (OS) and progression-free survival (PFS); the secondary outcome was the treatment response. RESULTS Twenty-two PCL patients (14 males, 8 females; age: 59.5 ± 14.7 years [mean ± S.D.]) were histologically confirmed to have diffuse large B-cell lymphoma (DLBCL; n = 17 [77.3%]), fibrin-associated DLBCL (FA-DLBCL) (n = 4 [18.2%]) and Burkitt lymphoma (n = 1 [4.5%]). Seven patients underwent cardiotomy (three for biopsy, four with curative intent). The median and longest follow-up periods were 16.3 and 180.0 months, respectively. The 16 patients who received curative therapy (complete response [CR], n = 15 [93.8%]; partial response [PR], n = 1 [6.2%]) showed better survival than those who did not (5-year OS: 83.0 ± 11.3% vs. 0%; hazard ratio [HR]: 0.025[95% confidence interval, CI: 0.003-0.187], p < 0.001); 5-year PFS: 78.7 ± 11.0% vs. 0%, HR= 0.010[0.001-0.093], p < 0.001). The left ventricular ejection fractions (LVEF) before and after definitive treatment was 63.6 ± 2.4% and 64.6 ± 4.5%, respectively (p = 0.275, power = 0.318). Extrapericardial lesions were associated with poorer survival (5-year OS: 40.0 ± 29.7% vs. 100%, p = 0.027; 5-year PFS:40.0 ± 21.9% vs. 100%, p = 0.010). CONCLUSIONS Whole-body imaging is essential for diagnosis and prognosis. Curative therapy provided reasonable outcomes and survival; extrapericardial lesions were associated with a poorer treatment response.
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Affiliation(s)
- Xiao-Juan Wei
- Department of Clinical Oncology, Division of lymphoma, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P. R. China
| | - Hui Yuan
- Department of Nuclear Medicine, Guangdong Academy of Medical Sciences & Guangdong Provincial People's Hospital, Guangzhou, Guangdong, P. R. China
| | - Pek-Lan Khong
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, P. R. China
| | - Fen Zhang
- Department of Pathology, Guangdong Academy of Medical Sciences & Guangdong Provincial People's Hospital, Guangzhou, Guangdong, P. R. China
| | - Peng-Jun Liao
- Department of Haematology, Guangdong Academy of Medical Sciences & Guangdong Provincial People's Hospital, Guangzhou, Guangdong, P. R. China
| | - Xin-Miao Jiang
- Department of Clinical Oncology, Division of lymphoma, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P. R. China
| | - Ling Huang
- Department of Clinical Oncology, Division of lymphoma, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P. R. China
| | - Han-Guo Guo
- Department of Clinical Oncology, Division of lymphoma, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P. R. China
| | - Fei-Li Chen
- Department of Clinical Oncology, Division of lymphoma, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P. R. China
| | - Si-Chu Liu
- Department of Clinical Oncology, Division of lymphoma, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P. R. China
| | - Yan-Ying Huang
- Department of Cardiology, Guangdong Academy of Medical Sciences & Guangdong Provincial People's Hospital, Guangzhou, Guangdong, P. R. China
| | - Shu-Xia Wang
- Department of Nuclear Medicine, Guangdong Academy of Medical Sciences & Guangdong Provincial People's Hospital, Guangzhou, Guangdong, P. R. China
| | - Wen-Yu Li
- Department of Clinical Oncology, Division of lymphoma, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P. R. China
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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] [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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31
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Miyawaki M, Aoyama R, Ishikawa J, Harada K. Primary cardiac B cell lymphoma in an immunocompetent patient. BMJ Case Rep 2021; 14:14/7/e243068. [PMID: 34312135 PMCID: PMC8314727 DOI: 10.1136/bcr-2021-243068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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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32
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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] [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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Serra V, De Luca F, Savino K, Pinto MD, Castellani C, Fiaschini P, Tomasello L, Cavallini C. Syncope and Cardiac Tamponade: Multimodality Imaging of Primary Cardiac Lymphoma. J Cardiovasc Echogr 2021; 31:42-44. [PMID: 34221886 PMCID: PMC8230158 DOI: 10.4103/jcecho.jcecho_109_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/05/2020] [Indexed: 11/04/2022] Open
Abstract
Primary cardiac lymphoma (PCL) is among the rarest heart neoplasms. Its estimated incidence is about 1%-2% among primary cardiac tumor and 0.5% of extranodal lymphoma. It usually causes heart failure, pericardial effusion, tamponade, and arrhythmias. Prognosis is poor; treatment is combined medical and surgical. We described the case of a 62-year-old male with PLC that presented with syncope and cardiac tamponade, submitted to R-CHOP therapy because of failure of surgery. Clinical state is stable 3 months after diagnosis and first chemotherapy cycle.
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Affiliation(s)
- Virginia Serra
- Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
| | - Francesco De Luca
- Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
| | - Ketty Savino
- Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
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34
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Alansari YE, Yudhistiara B, Michel RP, Elstein E. Case report: multimodality imaging to diagnose cardiac diffuse large B-cell lymphoma. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab172. [PMID: 34124570 PMCID: PMC8189295 DOI: 10.1093/ehjcr/ytab172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/21/2020] [Accepted: 04/15/2021] [Indexed: 11/15/2022]
Abstract
Background Primary cardiac lymphoma (PCL) is rare and can present with a wide variety of clinical symptoms, frequently leading to a delay in diagnosis. Case summary We report a case of a PCL in an 81-year-old man. Cardiac magnetic resonance imaging showed multiple masses in the right atrium and a mass in the right ventricular outflow tract extending to the pulmonary artery. Biopsy revealed a diffuse large B-cell lymphoma. The patient also had metastases to the liver and lung on the positron emission tomography–computed tomography (PET–CT) scan. He was treated with R-CHOP chemotherapy, with complete remission documented PET–CT scans. Conclusion Although most patients with PCL die before chemotherapy can be initiated, a timely diagnosis can result in a favourable outcome.
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Affiliation(s)
- Yahya E Alansari
- Division of Cardiology, Department of Medicine, McGill University, 1009 rue de Bleury, Apt 1009, Montréal, QC H2Z 0A3, Canada
| | - Brian Yudhistiara
- College of Medicine, Heidelberg University, Grabengasse 1, Heidelberg, 69117 Germany
| | - René P Michel
- Department of Pathology, McGill University, 1009 rue de Bleury, Apt 1009, Montréal, QC H2Z 0A3,Canada
| | - Eleanor Elstein
- Division of Cardiology, Department of Medicine, McGill University, 1009 rue de Bleury, Apt 1009, Montréal, QC H2Z 0A3, Canada
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35
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Zaidi A, Sekar B, Yousef Z. Broad complex tachycardia in a 46-year-old man. Heart 2021; 106:602-623. [PMID: 32217733 DOI: 10.1136/heartjnl-2019-316397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Abbas Zaidi
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Baskar Sekar
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Zaheer Yousef
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
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36
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Specktor P, Yalonetsky S, Agmon Y, Sprecher E, Ali FH, Telman G. The effect of TEE on treatment change in patients with acute ischemic stroke. PLoS One 2020; 15:e0243142. [PMID: 33270736 PMCID: PMC7714247 DOI: 10.1371/journal.pone.0243142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022] Open
Abstract
Background and purpose Ischemic stroke is a widespread disease carrying high morbidity and mortality. Transesophageal echocardiography (TEE) is considered an important tool in the work-up of patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA) patients; its utility is limited by a semi-invasive nature. The purpose of this study was to evaluate the probability of treatment change due to TEE findings (yield) in the work-up of AIS and TIA patients. Methods Retrospective data on patients with AIS or TIA who underwent TEE examination between 2000–2013 were collected from the institutional registry. Results The average age of 1284 patients who were included in the study was 57±10.4, 66% of patients were male. The most frequent TEE findings included aortic plaques in 54% and patent foramen ovale (PFO) in 15%. TEE findings led to treatment change in 135 (10.5%) patients; anticoagulant treatment was initiated in 110 of them (81%). Most common etiology for switch to anticoagulation was aortic plaques (71 patients); PFO was second most common reason (26 patients). Significant TEE findings (thrombus, endocarditis, tumor) were found in 1.9% of patients, they were more common in young patients (<55; 56% of the patients). Conclusions The beginning of anticoagulation treatment in patients with thick and complicated plaques was found frequently in our study. Significant TEE findings, were infrequent, constituted an absolute indication for treatment change and were more common in younger patients.
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Affiliation(s)
- Polina Specktor
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Department of Neurology, Carmel Hospital, Haifa, Israel
| | | | - Yoram Agmon
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Elliot Sprecher
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Faten Haj Ali
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Gregory Telman
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Technion, Israel Institute of Technology, Haifa, Israel
- * E-mail:
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37
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Sultan I, Aranda-Michel E, Habertheuer A, Kilic A, Arnaoutakis G, Bianco V, Okusanya O. Long-Term Outcomes of Primary Cardiac Lymphoma. Circulation 2020; 142:2194-2195. [PMID: 33253006 DOI: 10.1161/circulationaha.120.047215] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, PA (I.S., E.AM., A.H., A.K., V.B., O.O.).,Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (I.S., A.K.)
| | - Edgar Aranda-Michel
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, PA (I.S., E.AM., A.H., A.K., V.B., O.O.)
| | - Andreas Habertheuer
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, PA (I.S., E.AM., A.H., A.K., V.B., O.O.)
| | - Arman Kilic
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, PA (I.S., E.AM., A.H., A.K., V.B., O.O.).,Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (I.S., A.K.)
| | | | - Valentino Bianco
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, PA (I.S., E.AM., A.H., A.K., V.B., O.O.)
| | - Olugbenga Okusanya
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, PA (I.S., E.AM., A.H., A.K., V.B., O.O.)
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38
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Al-Darzi WK, Hana A, Lahiri MK, Dagher C, Greenberg JC, Alaswad K, Rabbani BT, McCord JK, Reddy M. Diffuse B Cell Lymphoma Leading to Complete Heart Block: Is This Transient or Permanent? AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e925760. [PMID: 33093439 PMCID: PMC7592338 DOI: 10.12659/ajcr.925760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patient: Female, 72-year-old Final Diagnosis: Cardiac lymphoma Symptoms: Dyspnea on exertion Medication:— Clinical Procedure: — Specialty: Cardiology • Oncology
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Affiliation(s)
| | - Aeman Hana
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Marc K Lahiri
- Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | - Carina Dagher
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | | | | | - Bobak T Rabbani
- Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | - James K McCord
- Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | - Madhulata Reddy
- Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA
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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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40
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Suen HC, Hsin MKY. Commentary: Surgical resection has limited role in primary cardiac lymphoma. J Thorac Cardiovasc Surg 2020; 164:581-582. [PMID: 33618874 DOI: 10.1016/j.jtcvs.2020.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Hon Chi Suen
- The Hong Kong Sanitorium and Hospital, Hong Kong
| | - Michael K Y Hsin
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong.
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Tanking C, Ratanapo S. Diagnostic challenge in primary cardiac lymphoma: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 33204946 PMCID: PMC7649445 DOI: 10.1093/ehjcr/ytaa160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/11/2020] [Accepted: 05/19/2020] [Indexed: 11/13/2022]
Abstract
Background Primary cardiac lymphoma is an extra-nodal non-Hodgkin's lymphoma, which usually responds well to chemotherapy. The disease has high mortality rate unless it is recognized and treated in time. Tissue pathology is crucially the diagnosis gold standard for treatment plan. This is a case report of an elderly female who presented with a huge right-sided cardiac tumour obstructing tricuspid flow. Case summary An 81-year-old Asian female presented with clinical right-sided heart failure. Echocardiogram showed a large mass compressing and obliterating the right atrium. Trans-jugular tissue biopsy was performed. Initial pathology report was consistent with an angiosarcoma, based on an expression of Fli-1 (Friend leukaemia virus integration 1) from immunohistochemical staining. She died shortly after refusal to surgery. Autopsy was performed with diagnosis change to a diffuse large B-cell lymphoma (DLBCL) after tissue pathology. Discussion Primary cardiac lymphoma is extremely rare. Adequate tissue and proper immunohistochemical staining are mandatory for treatment plan. Besides an angiosarcoma, DLBCL should be considered in the differential diagnosis of Fli-1 positive tissue cardiac mass.
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Affiliation(s)
- Chonthicha Tanking
- Chulabhorn Hospital, 906 Kamphaeng Phet 6 Rd, Talat Bang Khen, Lak Si, Bangkok 10210, Thailand
| | - Supawat Ratanapo
- Phramongklutklao College of Medicine & Phramongklutklao Hospital, 315 Ratchawithi Rd, Thung Phaya Thai, Ratchathewi, Bangkok 10400, Thailand
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Fukuzaki H, Fukuda K, Sato A, Shiozaki M, Kubota N, Tamura H, Inoue K, Fujiwara Y, Sumiyoshi M. Primary Cardiac Diffuse Large B-cell Lymphoma Promptly and Safely Diagnosed with Pericardial Effusion Cytology. Intern Med 2020; 59:1997-2001. [PMID: 32350200 PMCID: PMC7492110 DOI: 10.2169/internalmedicine.4716-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Primary cardiac lymphoma is a rare condition with a poor prognosis, and patients are at risk for sudden cardiac death. A prompt diagnosis and early treatment are therefore essential. A 68-year-old woman was admitted for shortness of breath and peripheral edema. Echocardiograms showed massive pericardial effusion and a mass on the free wall of the right atrium and ventricle. Subsequent pericardial effusion cytology revealed diffuse large B-cell lymphoma. We started chemotherapy with rituximab and achieved a good clinical course. This case is made unique by the use of pericardial effusion cytology, which allowed us to diagnose primary cardiac lymphoma promptly and safely.
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Affiliation(s)
- Haruna Fukuzaki
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Kentaro Fukuda
- Department of Cardiology, Juntendo University Nerima Hospital, Japan
| | - Akihiro Sato
- Department of Cardiology, Juntendo University Nerima Hospital, Japan
| | - Masayuki Shiozaki
- Department of Cardiology, Juntendo University Nerima Hospital, Japan
| | - Naozumi Kubota
- Department of Cardiology, Juntendo University Nerima Hospital, Japan
| | - Hiroshi Tamura
- Department of Cardiology, Juntendo University Nerima Hospital, Japan
| | - Kenji Inoue
- Department of Cardiology, Juntendo University Nerima Hospital, Japan
| | - Yasumasa Fujiwara
- Department of Cardiology, Juntendo University Nerima Hospital, Japan
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Surgical treatment of a primary cardiac lymphoma presenting with cardiac tamponade. Gen Thorac Cardiovasc Surg 2020; 69:356-359. [PMID: 32749598 DOI: 10.1007/s11748-020-01455-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
Primary cardiac lymphoma (PCL) is one of the rarest tumors and the most common type is large B-cell lymphoma. The right atrium and right ventricle are the most often involved, which should be diagnosed and treated in time. In this case, a female patient underwent an emergency surgical treatment for a large pericardial effusion and a huge mass in the right atrium. The huge mass was resected successfully. The pathological evaluation suggested that PCL and staging systemic chemotherapy were initiated according to the result, which significantly improve the prognosis of and quality of life.
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Vezzosi T, Domenech O, Cipollini C, Cantile C, Côté E, Tognetti R. ECG of the Month. J Am Vet Med Assoc 2020; 255:1234-1236. [PMID: 31730434 DOI: 10.2460/javma.255.11.1234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Occult primary cardiac lymphomas causing unexpected/sudden death or acute heart failure. Virchows Arch 2020; 477:603-607. [PMID: 32372222 DOI: 10.1007/s00428-020-02819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 04/04/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
Three cases of unexpected/sudden death (N = 2) or acute heart failure (N = 1) were investigated in our centre. The first patient died unexpectedly after surgery for cardiac tamponade and constrictive pericarditis; at autopsy, gross features mimicked a pericardial mesothelioma. The second patient died suddenly after recovering from a respiratory insufficiency episode; autopsy revealed an epicardial mass encircling the right coronary artery. The third patient presenting symptoms mimicked a fulminant myocarditis and she underwent endomyocardial biopsy. In all cases, histology disclosed a diffuse large B cell non-Hodgkin lymphoma, localized to the pericardium together with the right ventricle and the conduction system, to the epicardium and the right coronary artery or to the myocardium, respectively. Histology was crucial for the diagnosis, the atypical presentation favouring other diagnostic hypotheses. Although primary cardiac lymphoma is uncommon and usually shows a sub-acute onset, it may also cause unexpected/sudden death or acute heart failure.
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Primary Cardiac Lymphoma. Indian J Hematol Blood Transfus 2020; 36:419-421. [DOI: 10.1007/s12288-019-01221-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/14/2019] [Indexed: 11/26/2022] Open
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Maas JA, Menes M, Siomin V. Cardiac Myxoma with Cerebral Metastases and Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: A Case Report and Review. J Neurol Surg Rep 2020; 81:e1-e6. [PMID: 32051810 PMCID: PMC7012640 DOI: 10.1055/s-0039-3399570] [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: 07/28/2019] [Accepted: 09/28/2019] [Indexed: 12/20/2022] Open
Abstract
Background
Cardiac myxomas, the most common primary cardiac tumors, are generally benign neoplasms. Primary cardiac lymphoma is a rare cardiac malignancy with a very poor prognosis. Here we present a case of a cardiac myxoma with cerebral metastases and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) arising within the cerebral metastases.
Case description
A 62-year-old man, who presented with symptoms of multiple transient ischemic attacks, was found to have a left atrial myxoma. Twelve months after excision of the myxoma, the patient experienced a recurrence of neurologic symptoms. Brain magnetic resonance imaging revealed multiple hemorrhagic masses. Craniotomy was performed to resect the lesions. Histopathologic examination confirmed cardiac myxoma metastases and a small lymphocytic infiltrate within the tumor consistent with CLL/SLL.
Conclusion
Including the present case, there are 27 cases of cardiac myxoma cerebral metastases and 22 cases of lymphomas arising within myxomas. The present case is the first known instance of both entities in the same patient. There is no standard management for either cardiac myxoma metastases or lymphoma within a myxoma. For both diseases, surgical excision is the primary treatment modality, but postoperative chemotherapy and/or radiation have been attempted. Myxomas may create a chronic inflammatory state that could lead to the development of CLL/SLL.
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Affiliation(s)
- Jared A Maas
- Department of Radiation Oncology, University of Alabama at Birmingham, Hazelrig Salter Radiation Oncology Center, Birmingham, Alabama, United States
| | - Manuel Menes
- Department of Pathology, Baptist Health South Florida, Miami, Florida, United States
| | - Vitaly Siomin
- Department of Neurosurgery, Baptist Health South Florida, Miami, Florida, United States
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Primary Cardiac Lymphoma Manifesting as Complete Heart Block. Case Rep Cardiol 2020; 2020:3825312. [PMID: 33062338 PMCID: PMC7537681 DOI: 10.1155/2020/3825312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 01/16/2020] [Indexed: 11/17/2022] Open
Abstract
Primary cardiac tumors are exceedingly rare with variable clinical manifestations. This case involves a patient presentation of symptomatic complete heart block and cardiac imaging revealing a right atrial mass invading the myocardium consistent with Burkitt lymphoma on histopathology. The patient received definitive bradytherapy with a pacemaker and chemotherapy for the primary cardiac lymphoma. After three cycles of chemotherapy, the right atrial mass regressed significantly with restoration of atrioventricular conduction and no pacing burden. Primary cardiac lymphomas infrequently manifest as atrioventricular block and this case highlights cardiac masses as a potential etiology when evaluating new conduction disturbances and bradyarrhythmias.
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Ng S, Krisnadi C, Low RJB, Yew MS. Tachy- and bradyarrhythmia as an initial presentation of human immunodeficiency virus-related primary cardiac lymphoma: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:1-7. [PMID: 31911982 PMCID: PMC6939799 DOI: 10.1093/ehjcr/ytz217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 07/30/2019] [Accepted: 11/12/2019] [Indexed: 11/22/2022]
Abstract
Background Primary cardiac lymphoma is defined as extranodal lymphoma involving the heart or pericardium. Common presentations of human immunodeficiency virus (HIV)-associated cardiac lymphoma include heart failure, cardiac tamponade, and rhythm abnormalities. Arrhythmia is an uncommon presentation and treatment in young HIV patients is particularly challenging. We present a unique case of primary cardiac lymphoma in an HIV patient presenting with both symptomatic tachy- and bradyarrhythmias. Case summary A 27-year-old man presented with intermittent palpitations and chest pain for 2 weeks. He has a significant past history of advanced HIV. He was noted to have complete heart block on cardiac monitoring. Imaging showed a large mass in the right atrioventricular (AV) groove extending into the myocardium, associated with a moderate pericardial effusion. During his stay, he developed symptomatic tachy–brady arrhythmias, with intermittent junctional tachycardia, supraventricular tachycardia, and complete AV block. After a multidisciplinary team discussion, endomyocardial biopsy was performed under fluoroscopy and transthoracic echocardiography guidance. Histology from the interventricular septum was consistent with Epstein–Barr virus positive B-cell lymphoma. The patient was subsequently transferred to a tertiary hospital with cardiothoracic surgical support to initiate chemotherapy. Discussion To our knowledge, our patient is the first reported case of HIV-related primary cardiac lymphoma presenting with palpitations secondary to paroxysmal supraventricular tachycardia with concomitant AV block. This case illustrates the utility of multi-modality imaging in the investigation of a cardiac mass and the importance of having a high index of suspicion for pathology, such as cardiac lymphoma in HIV patients complaining of apparently minor cardiac complaints.
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Affiliation(s)
- Shonda Ng
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Cindy Krisnadi
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Randal Jun Bang Low
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Min Sen Yew
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
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Indruchová P, Petr R, Benešová M, Zemanová I, Línková H. (A young patient with large myxoma in the right atrium). COR ET VASA 2019. [DOI: 10.1016/j.crvasa.2018.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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