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Khasawneh A, McGuinness G, Ward N. Initial diagnosis of extranodal NK/T-cell lymphoma in pericardial fluid with concomitant hemophagocytic lymphohistiocytosis (HLH). J Hematop 2024; 17:27-36. [PMID: 38376724 DOI: 10.1007/s12308-023-00572-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/16/2023] [Indexed: 02/21/2024] Open
Abstract
Extranasal natural killer/T-cell lymphoma arising in the heart is rare and typically presents with non-specific clinical symptoms, necessitating a biopsy for a definitive diagnosis. We report an unusual case of a 48-year-old male who initially presented with chest pain and shortness of breath. Subsequent diagnosis via pericardial fluid analysis, including flow cytometry and immunohistochemical stains, revealed extranasal NK/T-cell lymphoma without sinonasal involvement. The analysis identified neoplastic lymphoid cells expressing CD2, cytoplasmic CD3, Epstein-Barr virus, and CD56 and exhibiting increased Ki-67 staining. Additionally, the patient developed hemophagocytosis lymphocytosis secondary to NK/T cell lymphoma. Treatment included an interleukin-1 receptor antagonist (anakinra), dexamethasone, rituximab, and etoposide. Unfortunately, the patient's condition rapidly deteriorated, leading to multiorgan failure and eventual demise. Given the rarity of this lymphoma, early diagnosis based on a high suspicion level provides the best chance for improved overall survival.
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Affiliation(s)
- Amani Khasawneh
- Department of Pathology, New York University Langone Medical Center, 240 East 38Th Street, 22Nd Floor, New York, NY, USA
| | - Georgeann McGuinness
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Nicholas Ward
- Department of Pathology, New York University Langone Medical Center, 240 East 38Th Street, 22Nd Floor, New York, NY, USA.
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2
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Csizmar CM, Sachs Z, Cayci Z, Bu L, Linden MA. Primary Cardiac Lymphoma: Three Case Reports and a Review of the Literature. OPEN JOURNAL OF BLOOD DISEASES 2021; 11:120-132. [PMID: 34984108 PMCID: PMC8722531 DOI: 10.4236/ojbd.2021.114012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Primary cardiac lymphoma (PCL) is a rare entity that comprises only 1-2% of all cardiac tumors. Due to their scarcity and variable clinical presentation, early diagnosis is challenging. In this series, three cases of PCL from a single institution are described, which highlight the spectrum of presenting features and emphasize common principles. In the first case, a 73-year-old male who presented with dyspnea was found to have a 12.1 cm mass in the right ventricle. Biopsy via cardiac catheterization revealed diffuse large B cell lymphoma (DLBCL). He was treated with chemoimmunotherapy and survived for two months. The second case describes a 55-year-old female who presented with chest pain. Imaging revealed a 3.1 cm right atrial mass and bilateral pleural effusions, with cytology from the latter demonstrating DLBCL. She was lost to follow up after three cycles of chemoimmunotherapy. In the last case, an 80-year-old female presented with weakness. A 4.0 cm mass was discovered in the right atrium and the patient expired shortly after admission. Autopsy confirmed the diagnosis of DLBCL. These case summaries are followed by a review of the clinical presentation, diagnostic approach, and treatment outcomes of PCL.
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Affiliation(s)
| | - Zohar Sachs
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Zuzan Cayci
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Lihong Bu
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Michael Andrew Linden
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
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3
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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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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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5
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Chan O, Igwe M, Breburda CS, Amar S. Burkitt Lymphoma Presenting as an Intracardiac Mass: Case Report and Review of Literature. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:553-8. [PMID: 27484990 PMCID: PMC4973801 DOI: 10.12659/ajcr.899022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 27 Final Diagnosis: Burkitt lymphoma with intracardiac mass Symptoms: Dizziness • fatigue • palpitations • weight loss Medication: — Clinical Procedure: Catheter-directed thrombolytic therapy with intracardiac infusion of alteplase Specialty: Hematology
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Affiliation(s)
- Onyee Chan
- Department of Medicine, University of Arizona, Banner University Medical Center, Tucson, AZ, USA
| | - Michael Igwe
- Department of Medicine, Maricopa Integrated Health System, Phoenix, AZ, USA
| | | | - Surabhi Amar
- Department of Hematology Oncology, Maricopa Integrated Health System, Phoenix, AZ, USA
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Gordon MJ, Danilova O, Spurgeon S, Danilov AV. Cardiac non-Hodgkin's lymphoma: clinical characteristics and trends in survival. Eur J Haematol 2016; 97:445-452. [PMID: 26935129 DOI: 10.1111/ejh.12751] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The purpose of this study was to describe the clinical characteristics and outcomes in cardiac non-Hodgkin's lymphoma (NHL). METHODS A retrospective analysis of 94 cases of NHL with biopsy-proven cardiac involvement in PubMed between 1990 and 2015. RESULTS Among cases with cardiac involvement, diffuse large B-cell lymphoma was the most common histologic subtype (58%), followed by T-cell lymphoma (16%), Burkitt's lymphoma (9%), and small lymphocytic lymphoma (6%). Symptomatic heart failure was the most common clinical presentation (34%), and 20% of patients had no cardiac symptoms. Median survival was 3 months (range, 0-72) among all patients. Patients who presented with heart failure had inferior outcomes. Patients with primary, vs. secondary, cardiac involvement had a trend toward superior outcomes. Importantly, chemotherapy treatment was associated with a prolongation in median survival (18 vs. 1 month, HR 0.16, 95% CI, 0.47-0.54, P = 0.0003), and patients diagnosed in the chemo-immunotherapy era demonstrated a trend toward better outcomes. Median survival was not reached among patients with B-cell malignancies who were alive for 1 month after the diagnosis. CONCLUSION Pathologic lymphomatous involvement of cardiac tissue should be considered in the evaluation of patients with NHL. Durable remissions can be achieved in B-cell NHL with cardiac involvement, and thus, therapy should be considered in such cases.
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Affiliation(s)
- Max J Gordon
- Department of Internal Medicine, Oregon Health & Sciences University, Portland, OR, USA
| | - Olga Danilova
- Pathology & Lab Medicine, VA Portland Health Care Systems, Portland, OR, USA
| | - Stephen Spurgeon
- Department of Internal Medicine, Oregon Health & Sciences University, Portland, OR, USA.,Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Alexey V Danilov
- Department of Internal Medicine, Oregon Health & Sciences University, Portland, OR, USA. .,Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
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Qing X, Enbom E, Qing A, French S, Cai J. Plasmablastic lymphoma presenting as a large intracardiac mass and bilateral pleural effusions. Exp Mol Pathol 2016; 100:79-81. [DOI: 10.1016/j.yexmp.2015.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
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Bush LM, Urrutia JG, Rodriguez EA, Perez MT. AIDS-Associated Cardiac Lymphoma-A Review: Apropos a Case Report. J Int Assoc Provid AIDS Care 2014; 14:482-90. [PMID: 24482102 DOI: 10.1177/2325957414520981] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite treatment with potent and effective combination antiretroviral medications, the incidence of non-Hodgkin lymphoma (NHL) in the population living with HIV/AIDS remains significantly higher than that in noninfected individuals. The majority of the HIV-infected patients with NHL present with advanced stage extranodal disease of the B-cell phenotype. Lymphomas are the second most common tumors involving the heart in HIV-infected patients. Although the heart may serve as the primary focus of the lymphoma, in most HIV-related cases, cardiac lymphomatous involvement is part of a metastatic process that originated elsewhere.
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Affiliation(s)
- Larry M Bush
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA University of Miami-Miller School of Medicine, JFK Medical Center, Palm Beach County, FL, USA
| | - Jose G Urrutia
- Internal Medicine, University of Miami-Miller School of Medicine, JFK Medical Center, Palm Beach County, FL, USA
| | - Eduardo A Rodriguez
- Internal Medicine, University of Miami-Miller School of Medicine, JFK Medical Center, Palm Beach County, FL, USA
| | - Maria T Perez
- Division of Pathology and Laboratory Medicine, Integrated Regional Laboratory Pathology Services, JFK Medical Center, Palm Beach County, FL, USA
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Dahiya S, Ooi WB, Mallidi J, Sivalingam S, Steingart R. Primary testicular lymphoma with cardiac involvement in an immunocompetent patient: case report and a concise review of literature. Rare Tumors 2012; 4:e43. [PMID: 23087799 PMCID: PMC3475950 DOI: 10.4081/rt.2012.e43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 06/20/2012] [Accepted: 06/25/2012] [Indexed: 11/23/2022] Open
Abstract
Primary testicular lymphoma (PTL) is a rare testicular tumor representing less than 9% of all testicular cancers. PTL usually tends to spread to or relapse at nodal structures or extra-nodal sites such as contralateral testes, central nervous system, skin, lung, pleura, waldeyer's ring and soft tissues. We present a case of PTL with huge left atrial mass, an extremely unusual site of involvement. Early disease usually carries a good prognosis, whereas advanced stage carries an extremely poor prognosis. Herein, we report the complete remission to date in a patient with advanced stage PTL with huge left atrial mass, treated with systemic rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone and intrathecal methotrexate. A brief review of literature focusing on various aspects of management of primary testicular lymphoma and lymphomatous involvement of heart is also discussed.
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Affiliation(s)
- Saurabh Dahiya
- Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
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Desgranges ZP, Deubner H, Broudy VC, Chen MA. Burkitt Lymphoma of the Heart. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2011. [DOI: 10.1177/8756479311413925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The incidence of non-Hodgkin lymphoma has increased over the past 10 years, particularly in association with human immunodeficiency virus (HIV) infection. Burkitt lymphoma is a highly aggressive non-Hodgkin lymphoma that involves the heart in up to a third of cases. This case describes an HIV-positive patient with cardiac involvement of Burkitt lymphoma who presented with atrial flutter and heart failure with pulmonary edema. Transthoracic echocardiography showed extensive heterogeneous lymphomatous infiltration of the heart (including the right atrium), with associated wall motion abnormalities. Within a day of starting chemotherapy, the patient had converted to normal sinus rhythm. His heart failure rapidly improved, and a repeat echocardiogram performed on day 5 of chemotherapy showed a significant reduction in myocardial tumor burden and improved cardiac function. This case demonstrates how echocardiography plays a significant role in diagnosis, management, and follow-up of lymphoma (in this case Burkitt) with cardiac involvement.
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Affiliation(s)
- Zana P. Desgranges
- Department of Internal Medicine, Harborview Medical Center, University of Washington, Seattle, USA
| | - Heike Deubner
- Department of Pathology, Harborview Medical Center, University of Washington, Seattle, USA
| | - Virginia C. Broudy
- Department of Internal Medicine, Division of Hematology Oncology, Harborview Medical Center, University of Washington, Seattle, USA
| | - Michael A. Chen
- Department of Internal Medicine, Division of Cardiology, Harborview Medical Center, University of Washington, Seattle, USA
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11
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Cardiac tumors: optimal cardiac MR sequences and spectrum of imaging appearances. AJR Am J Roentgenol 2009; 193:377-87. [PMID: 19620434 DOI: 10.2214/ajr.08.1895] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This article reviews the optimal cardiac MRI sequences for and the spectrum of imaging appearances of cardiac tumors. CONCLUSION Recent technologic advances in cardiac MRI have resulted in the rapid acquisition of images of the heart with high spatial and temporal resolution and excellent myocardial tissue characterization. Cardiac MRI provides optimal assessment of the location, functional characteristics, and soft-tissue features of cardiac tumors, allowing accurate differentiation of benign and malignant lesions.
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12
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Gaspar A, Salomé N, Nabais S, Brandão A, Simões A, Portela C, Salgado A, Pereira A, Correia A. Echocardiographic assessment of a cardiac lymphoma: beyond two-dimensional imaging. ACTA ACUST UNITED AC 2009; 10:975-8. [DOI: 10.1093/ejechocard/jep092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Legault S, Couture C, Bourgault C, Bergeron S, Poirier P, Sénéchal M. Primary cardiac Burkitt-like lymphoma of the right atrium. Can J Cardiol 2009; 25:163-5. [PMID: 19279985 DOI: 10.1016/s0828-282x(09)70049-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 74-year-old man presented for shortness of breath. Echocardiography revealed the presence of a large pericardial effusion with signs of tamponade. A right atrial mass was suspected and later confirmed by transesophageal echocardiography. The mass was attached to the right side of the interatrial septum. Surgical resection was performed. Histology was compatible with a diagnosis of undifferentiated B-cell non-Hodgkin's (Burkittlike) primary cardiac lymphoma. The present report provides the first description of a Burkitt-like primary cardiac lymphoma. The presence of a mass in the right atria should raise the possibility of a malignant cardiac tumour. Transesophageal echocardiography should be considered as the initial diagnostic procedure to be performed. Rapid histological diagnosis is important because systemic therapy can influence prognosis in the presence of a primary cardiac lymphoma.
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Affiliation(s)
- S Legault
- Department of Cardiology, Quebec Heart Institute, Laval Hospital, Quebec City, Canada
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Abstract
Lymphomas arising in extranodal sites are intriguing. The types of lymphomas encountered vary widely from one extranodal site to another. For many types of extranodal lymphomas, there are distinctive clinicopathologic features, sometimes including association with an underlying immunodeficiency syndrome, autoimmune disease, infection, or other immunologic disorder, or a predilection to affect patients of certain ethnic origins. Presented below is a review of lymphomas that are encountered most often in extranodal sites.
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Affiliation(s)
- Judith A Ferry
- Department of Pathology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.
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Mendiolaza J, Baltasar JFT, Anis A, Harrison J, Chen F, Klapholz M, Saric M. Left ventricular non-Hodgkin lymphoma visualized on contrast echocardiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:462-4. [PMID: 17373683 DOI: 10.1002/jcu.20344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We present a case of AIDS-related Burkitt's type cardiac lymphoma in a middle-aged woman with Epstein-Barr virus infection and profound immunodeficiency. The original features of our case include left ventricular location, female sex, and the use of contrast echocardiography to help establish the diagnosis.
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Affiliation(s)
- Jesús Mendiolaza
- Department of Medicine, New Jersey Medical School, 185 South Orange Avenue I-538, University Heights, Newark, NJ 07103, USA
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Abstract
Patient case:
A 48-year-old man with human immunodeficiency virus (HIV) infection developed chronic chest pain that started after a bout of pneumonia. He has hypertension and has smoked cigarettes in the past. His current medications include Kaletra and Combivir. His total cholesterol was 331 mg/L, his HDL cholesterol was 27 mg/L, his triglycerides were 935 mg/L, and his LDL cholesterol could not be calculated. How should this patient be evaluated and managed?
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Affiliation(s)
- Priscilla Y Hsue
- Division of Cardiology, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA
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