1
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Robak T, Puła A, Braun M, Robak E. Extramedullary and extranodal manifestations in chronic lymphocytic leukemia - an update. Ann Hematol 2024; 103:3369-3383. [PMID: 39052034 PMCID: PMC11358350 DOI: 10.1007/s00277-024-05854-1] [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: 03/26/2024] [Accepted: 06/15/2024] [Indexed: 07/27/2024]
Abstract
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is a common leukemia characterized by clonal expansion of mature CD5+/CD23 + B cells in the blood, bone marrow (BM) and lymphoid tissues. CLL can undergo extramedullary and extranodal infiltration, with one study noting an incidence of only 0.3 per 100,000 people, and in 17.6% of CLL patients in another report. The most common extranodal sites of leukemic involvement are the skin and central nervous system; however, other organs, including liver, lungs, kidney, gastrointestinal tract, bone, prostate and heart, are occasionally involved. The prognostic significance of extra-medullary CLL is still under debate, but the prognosis in such patients seems to be better in the era of novel targeted drugs. Following a diagnosis of extranodal CLL, survival appears to depend on the site of infiltration. This review presents an overview of CLL in patients with extramedullary and extranodal leukemic lesions, focusing on its epidemiology, pathogenesis, prognosis, clinical characteristics and treatment results.
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Affiliation(s)
- Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Ciołkowskiego 2, Lodz, 93-510, Poland.
- Department of General Hematology, Copernicus Memorial Hospital, Lodz, Poland.
| | - Anna Puła
- Department of Hematology, Medical University of Lodz, Ciołkowskiego 2, Lodz, 93-510, Poland
- Department of Hematooncology, Copernicus Memorial Hospital, Lodz, Poland
| | - Marcin Braun
- Department of Pathology, Chair of Oncology, Medical University of Lodz, Lodz, Poland
| | - Ewa Robak
- Department of Dermatology, Medical University of Lodz, Lodz, Poland
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2
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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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3
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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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4
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Huang X, Wang S, Mei C, Xu Y, Wu X, Du F, Ren Y, Jin J, Tong H, Qian J. Overcoming right heart failure through successful treatment of cardiac dominant diffuse large B-cell lymphoma: a case report. Ann Hematol 2024; 103:343-345. [PMID: 37736807 DOI: 10.1007/s00277-023-05467-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Xianbo Huang
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Shasha Wang
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Chen Mei
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Yu Xu
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Xianhui Wu
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Fengwei Du
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yanling Ren
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China.
| | - Hongyan Tong
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China.
| | - Jiejing Qian
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China.
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5
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Prakash A, Khalid F, Gandhi H, Mungalpara D. A Rare Case of Atrial Septal Mass Secondary to Lymphoma: Case Report and Review of Literature. J Investig Med High Impact Case Rep 2024; 12:23247096241273108. [PMID: 39171698 PMCID: PMC11342325 DOI: 10.1177/23247096241273108] [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: 05/16/2024] [Revised: 06/29/2024] [Accepted: 07/08/2024] [Indexed: 08/23/2024] Open
Abstract
The antemortem diagnosis of secondary cardiac involvement by lymphoma remains suboptimal. Prognosis is worse with delayed diagnosis as the tumor burden increases with the multicompartment participation. Chemotherapy may improve survival, but there is a risk of mortality due to treatment-related complications, such as myocardial rupture and fatal arrhythmias. Modified chemotherapy regimens may prevent such complications, but the data are limited. We report the case of a 72-year-old woman diagnosed with diffuse large B-cell lymphoma with cardiac involvement, where early diagnosis prevented cardiac complications from the disease and its treatment as well. The aim of this case report is to highlight the fact that cardiac involvement in lymphoma is frequent and can be easily missed, leading to complications. Treatment requires an individualized approach.
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6
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Raciti CG, Alakhras H, Strubchevska K, Timmis S, Kozyk M. A Rare Case of Cardiac Tamponade Induced by Chronic Lymphocytic Leukemia. Cureus 2023; 15:e51271. [PMID: 38288237 PMCID: PMC10824367 DOI: 10.7759/cureus.51271] [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: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
While cardiac tamponade is a commonly recognized complication in solid organ malignancies and acute leukemias, instances of cardiac involvement in the context of chronic hematologic malignancies, such as chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), are rarely observed. A 66-year-old male, with a history of stage IV CLL/SLL, presented with three weeks of worsening edema, orthopnea, and dyspnea. Two days after admission, an echocardiogram revealed a large circumferential pericardial effusion. Given the concern about early signs of pericardial tamponade, the patient underwent emergent pericardiocentesis with the removal of 700 cc of sanguineous fluid. A pericardial biopsy and flow cytometry of the pericardial fluid confirmed the diagnosis of CLL/SLL with pericardial involvement. There were no signs of large cell lymphoma transformation at that point. This rare case demonstrates the importance of considering cardiac complications in CLL/SLL patients who present with worsening edema, orthopnea, and dyspnea.
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Affiliation(s)
- Catherine G Raciti
- Internal Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, USA
| | - Hazem Alakhras
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Kateryna Strubchevska
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Steven Timmis
- Cardiovascular Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Marko Kozyk
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
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7
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Wang W, Zhang Z, Deng X, Gu A, Chen X, Cai Y, Zhao Y. Radiotherapy for Non-Hodgkin's lymphoma with cardiac infiltration: A case report. Front Oncol 2023; 13:1234831. [PMID: 37916159 PMCID: PMC10616872 DOI: 10.3389/fonc.2023.1234831] [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: 06/05/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023] Open
Abstract
Background Non-Hodgkin's lymphoma (NHL) with cardiac infiltration has a poor prognosis. The median OS of patients failing to respond to chemotherapy has been reported to be 1 month vs. 18 months in patients responding to chemotherapy. Case presentation Herein, we reported a case of a 57-year-old male confirmed with diffuse large B-cell lymphoma who received radiation therapy of 150-cGy daily, administered in 30 fractions to the volume of cardiac infiltration, resulting in complete relief. Chemotherapy had no curative effect. The patient was subsequently enrolled in a clinical trial and received oral administration of zanubrutinib 80mg twice daily, after which he achieved complete remission. The progression-free survival was from diagnosis (January 7, 2020) to the follow-up (September 20, 2022), amounting to 32 months. Conclusion Proper irradiation dose and timing of treatment can relieve NHL symptoms.
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Affiliation(s)
- Weifeng Wang
- Department of Radiation Oncology, Hainan Cancer Hospital, Haikou, China
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8
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Mahmoud AA, Abdelhay A, Mostafa M, Mohamed MS, Alam Z, Reid RM. Relapsed chronic lymphocytic leukemia with a cardiac mass: A case report. Radiol Case Rep 2023; 18:1963-1967. [PMID: 36970240 PMCID: PMC10034391 DOI: 10.1016/j.radcr.2023.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/19/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is the most common hematological malignancy in the USA. Extra-medullary disease is very rare and is not well characterized. In practice, clinically significant cardiac or pericardial involvement by CLL is extremely rare with only a few case reports in literature. We report a 51-year-old male patient with a past medical history of CLL in remission, who presented with fatigue, dyspnea on exertion, night sweats and left supraclavicular lymphadenopathy. Laboratory investigations were notable for leukopenia and thrombocytopenia. Due to high suspicion of an underlying malignant process, a full body computerized tomography (CT) scan was obtained and showed an 8.8 cm soft tissue mass-like lesion occupying the majority of the right atrium and extending into the right ventricle, with probable pericardial involvement. Enlarged left supraclavicular and mediastinal lymph nodes were also present and had a mild mass effect on the traversing left internal thoracic artery and left pulmonary artery. A transesophageal echocardiogram and cardiac magnetic resonance imaging (MRI) were done to better characterize the cardiac mass. They confirmed a large infiltrating mass (measuring 10 × 7.4 cm) in the right atrium and ventricle, extending into the inferior vena cava inferiorly and coronary sinus posteriorly. A left supraclavicular excisional lymph node biopsy was performed and histopathology was consistent with Small Lymphocytic Lymphoma (SLL)/CLL. This case represents one of the few known cases of cardiac extramedullary-CLL presenting with an isolated cardiac mass. Further studies are needed to characterize the course of the disease, prognosis and optimum management along with the role of surgery.
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Affiliation(s)
- Amir A. Mahmoud
- Department of Medicine, Rochester General Hospital, 1425 Portland Ave, New York, NY 14621, USA
- Corresponding author.
| | - Ali Abdelhay
- Department of Medicine, Rochester General Hospital, 1425 Portland Ave, New York, NY 14621, USA
| | - Mariam Mostafa
- Department of Medicine, Rochester General Hospital, 1425 Portland Ave, New York, NY 14621, USA
| | - Mohamed Salah Mohamed
- Department of Medicine, Rochester General Hospital, 1425 Portland Ave, New York, NY 14621, USA
| | - Zuhair Alam
- Department of Hematology and Medical Oncology, Rochester General Hospital, New York, NY, USA
| | - Robin M. Reid
- Department of Hematology and Medical Oncology, Rochester General Hospital, New York, NY, USA
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9
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Irqsusi M, Gerlach SV, Rastan AJ, Ghazy T. Invasive Giant B-Cell Lymphoma Mimicking Fulminant Pulmonary Embolism. Thorac Cardiovasc Surg Rep 2023; 12:e21-e23. [PMID: 36987438 PMCID: PMC10040259 DOI: 10.1055/s-0043-1764473] [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: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 03/29/2023] Open
Abstract
Background
Cardiac non-Hodgkin's lymphoma is rare and has a poor prognosis. Here we report a rare case mimicking pulmonary embolism.
Case Description
A 38-year-old woman suffered from severe dyspnea after cesarean section. With the clinical picture of fulminant central pulmonary embolism, lysis therapy was initiated. Further deterioration necessitated extracorporeal membrane oxygenation (ECMO) support and cardiosurgical intervention. Intraoperatively, a massive intravascular tumor obstructed the pulmonary bifurcation and was found to be B-cell lymphoma. Aggressive excision and pulmonary tree reconstruction improved the critical condition and initiated convalescence.
Conclusion
High suspicion in central pulmonary embolism and early cardiosurgical therapy after ineffective lysis are essential.
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Affiliation(s)
- Marc Irqsusi
- Department of Heart Surgery, University Hospital, Philipps University of Marburg, Marburg, Germany
- Address for correspondence Marc Irqsusi, MD Department of Heart Surgery, University Hospital, Philipps University MarburgBaldinger Str. 1, 35039 MarburgGermany
| | | | - Ardawan Julian Rastan
- Department of Heart Surgery, University Hospital, Philipps University of Marburg, Marburg, Germany
| | - Tamer Ghazy
- Department of Heart Surgery, University Hospital, Philipps University of Marburg, Marburg, Germany
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10
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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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11
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Robak T, Kasprzak JD, Jesionek-Kupnicka D, Soin M, Robak P. Small lymphocytic lymphoma in the heart twenty years after lymphoma diagnosis. Leuk Lymphoma 2023; 64:884-888. [PMID: 37061955 DOI: 10.1080/10428194.2023.2181657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Poland
- Department of General Hematology, Copernicus Memorial Hospital, Lodz, Poland
| | | | | | - Michał Soin
- Department of Hematology, Medical University of Lodz, Poland
- Department of General Hematology, Copernicus Memorial Hospital, Lodz, Poland
| | - Paweł Robak
- Department of Hematooncology, Copernicus Memorial Hospital, Lodz, Poland
- Department of Experimental Hematology, Medical University of Lodz, Poland
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12
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Yang Y, Li Z, Li Y, Zhao Y, Shi M. Relapsed/refractory diffuse large B cell lymphoma with cardiac involvement: A case report and literature review. Front Oncol 2023; 13:1091074. [PMID: 36793603 PMCID: PMC9923120 DOI: 10.3389/fonc.2023.1091074] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023] Open
Abstract
Background Hematological malignancies of the heart (CHMs) are extremely rare, and include leukemia, lymphoma infiltration, and multiple myeloma with extramedullary manifestations. Cardiac lymphoma can be divided into primary cardiac lymphoma (PCL) and secondary cardiac lymphoma (SCL). Compared to PCL, SCL is relatively more common. Histologically, the most frequent SCL is diffuse large B-cell lymphoma (DLBCL). The prognosis of lymphoma in patients with cardiac involvement is extremely poor. CAR T-cell immunotherapy has been recently become a highly effective treatment for relapsed or refractory diffuse large B-cell lymphoma. To date, there are no guidelines that provide a clear consensus on the management of patients with secondary heart or pericardial involvement. We report a case of relapsed/refractory DLBCL that secondarily affected the heart. Case presentation A male patient was diagnosed with double-expressor DLBCL based on biopsies of mediastinal and peripancreatic masses and fluorescence in situ hybridization. The patient received first-line chemotherapy and anti-CD19 CAR T cell immunotherapy, but developed heart metastases after 12 months. Considering his physical condition and economic situation of the patient, two cycles of multiline chemotherapies were administered, followed by CAR-NK cell immunotherapy and allogeneic hematopoietic stem cell transplantation (allo-HSCT) at another hospital. After achieving a six-month survival, the patient died of severe pneumonia. Conclusion The response of our patient emphasizes the importance of early diagnosis and timely treatment to improve the prognosis of SCL and serves as an important reference for SCL treatment strategies.
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Affiliation(s)
- Yuanyuan Yang
- Department of Hematology, the First Affiliated Hospital of Kunming Medical University, Kunming, China.,Hematology Research Center of Yunnan Province, Kunming, China
| | - Zixuan Li
- Department of Hematology, the First Affiliated Hospital of Kunming Medical University, Kunming, China.,Hematology Research Center of Yunnan Province, Kunming, China
| | - Yuntao Li
- Department of Hematology, the First Affiliated Hospital of Kunming Medical University, Kunming, China.,Hematology Research Center of Yunnan Province, Kunming, China
| | - Yue Zhao
- Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Mingxia Shi
- Department of Hematology, the First Affiliated Hospital of Kunming Medical University, Kunming, China.,Hematology Research Center of Yunnan Province, Kunming, China
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13
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Bonelli A, Paris S, Bisegna S, Milesi G, Gavazzi E, Giubbini R, Cattaneo C, Facchetti F, Faggiano P. Cardiac lymphoma with early response to chemotherapy: A case report and review of the literature. J Nucl Cardiol 2022; 29:3044-3056. [PMID: 33709334 PMCID: PMC9834346 DOI: 10.1007/s12350-021-02570-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 01/22/2023]
Abstract
Cardiac tumors are rare and benign masses account for the most part of the diagnosis. When malignant cancer is detected, primary or secondary cardiac lymphoma are quite frequent. Cardiac lymphoma may present as an intra or peri-cardiac mass or, rarely, it may diffusely infiltrate the myocardium. Although often asymptomatic, patients can have non-specific symptoms. Acute presentations with cardiogenic shock, unstable angina, or acute myocardial infarction are also described. Modern imaging techniques can help the clinicians not only in the diagnostic phase but also during administration of chemotherapy. A multidisciplinary counseling and serial multi-parametric assessment (echocardiography, cardiac troponin) seem to be the most effective approach to prevent possible fatal complications (i.e., cardiac rupture). Currently, only chemo- and radiotherapy are available options for treatment, but the prognosis remains poor. This is a case of secondary cardiac lymphoma presenting as a mediastinal mass with large infiltration of the heart and the great vessels with a good improvement after only one cycle of chemotherapy. It demonstrates the importance of an early diagnosis to modify the natural history of the disease.
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Affiliation(s)
- Andrea Bonelli
- Cardiology Unit, Spedali Civili and University of Brescia, Piazza Spedali Civili, Brescia, Italy.
| | - Sara Paris
- Cardiology Unit, Spedali Civili and University of Brescia, Piazza Spedali Civili, Brescia, Italy
| | - Stefano Bisegna
- Cardiology Unit, Spedali Civili and University of Brescia, Piazza Spedali Civili, Brescia, Italy
| | - Giuseppe Milesi
- Cardiology Unit, Spedali Civili and University of Brescia, Piazza Spedali Civili, Brescia, Italy
| | - Emanuele Gavazzi
- Department of Radiological Sciences, Spedali Civili and University of Brescia, Piazza Spedali Civili, Brescia, Italy
| | - Raffaele Giubbini
- Nuclear Medicine Unit, Spedali Civili and University of Brescia, Piazza Spedali Civili, Brescia, Italy
| | - Chiara Cattaneo
- Hematology Unit, Spedali Civili and University of Brescia, Piazza Spedali Civili, Brescia, Italy
| | - Fabio Facchetti
- Pathological Anatomy Service, Spedali Civili and University of Brescia, Piazza Spedali Civili, Brescia, Italy
| | - Pompilio Faggiano
- Cardiology Unit, Spedali Civili and University of Brescia, Piazza Spedali Civili, Brescia, Italy
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14
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Yang Y, Chen P, Liu L, Lin J, Huang S. The value of 18F-FDG PET/CT in evaluating the efficacy of chemotherapy for diffuse large B-cell lymphoma with cardiac involvement. J Nucl Cardiol 2022; 29:3548-3553. [PMID: 33660215 DOI: 10.1007/s12350-021-02551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Yuhua Yang
- Department of PET/CT, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Peiyin Chen
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Lisha Liu
- Department of PET/CT, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Juyi Lin
- Department of PET/CT, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Shengcai Huang
- Department of PET/CT, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, China.
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15
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Robak T, Kasprzak JD, Jesionek-Kupnicka D, Chudobiński C, Robak P. Cardiac Involvement in Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. J Clin Med 2022; 11:6983. [PMID: 36498556 PMCID: PMC9737627 DOI: 10.3390/jcm11236983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Cardiac involvement of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is recognized extremely rarely. In addition, most CLL/SLL patients with heart infiltration are asymptomatic. In this review, we present the results of a literature search for English language articles concerning CLL/SLL or Richter transformation with symptomatic cardiac involvement. In total, 18 well-described cases with CLL/SLL and heart infiltration were identified. Only three patients were not diagnosed with CLL/SLL before the cardiac manifestation. In other patients, cardiac CLL/SLL was diagnosed between 5 months and 20 years from CLL/SLL diagnosis. All patients in these series had a diagnosis of secondary cardiac CLL/SLL. In addition, we identified four reported cases with Richter transformation in the heart. The treatment of patients with CLL/SLL and cardiac infiltration is variable and depends on the previous history and clinical characteristics of heart infiltration. In addition, no recommendations exist on how to treat patients with CLL/SLL and cardiac involvement.
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Affiliation(s)
- Tadeusz Robak
- Department of Hematology, Medical University of Lodz, 93-510 Lodz, Poland
- Department of General Hematology, Copernicus Memorial Hospital, 93-510 Lodz, Poland
| | | | | | - Cezary Chudobiński
- Department of Radiology, Copernicus Memorial Hospital, 93-510 Lodz, Poland
| | - Paweł Robak
- Department of Oncohematology, Copernicus Memorial Hospital, 93-510 Lodz, Poland
- Department of Experimental Hematology, Medical University of Lodz, 93-510 Lodz, Poland
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16
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Gordon MJ, Ferrajoli A. Unusual complications in the management of chronic lymphocytic leukemia. Am J Hematol 2022; 97 Suppl 2:S26-S34. [PMID: 35491515 DOI: 10.1002/ajh.26585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 02/04/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is a common, indolent disease that typically presents with a proliferation of mature, immunologically dysfunctional CD5+ B-cells which preferentially occupy the bone marrow, peripheral blood and lymphoid organs. Immune dysfunction leads to an increase in autoimmune diseases which occur in approximately 10% of patients with CLL. Autoimmune cytopenias are the most common, but other organs may be affected as well. The treatment of these conditions typically depends on the extent of CLL and severity of symptoms, but generally consists of CLL-directed therapies, immunosuppression or both. CLL may also infiltrate extranodal sites in the body. Symptomatic extranodal CLL or extranodal disease which threatens normal organ function is an indication for initiation of CLL-directed therapy. The following review summarizes autoimmune and extranodal complications that can occur in patients with CLL and our suggested approach to their treatment.
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Affiliation(s)
- Max J Gordon
- MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
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17
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Chen P, Hao Y, Qiu X, Xiao X, Zhu W, Xu Y, Qian W. Case Report: Primary Cardiac T-Cell Lymphoma With Complete Atrio-Ventricular Block Diagnosed by Endomyocardial Biopsy. Front Immunol 2022; 13:890059. [PMID: 35784303 PMCID: PMC9244709 DOI: 10.3389/fimmu.2022.890059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Primary cardiac lymphoma (PCL) is a rare disease, the definite diagnosis of which is sometimes difficult and mainly relies on endomyocardial biopsy. Primary cardiac T-cell lymphoma (PCTL) is an extremely rare sub-type of PCL. Here, we report on a 47-year-old female with PCTL who presented with fever, syncope, palpitations, and a third-degree atrioventricular block (AVB) on electrocardiogram. Chemotherapy was administered with two courses of methotrexate, cyclophosphamide, liposomal doxorubicin, vincristine, and dexamethasone (MTX-CHOP). As the tumor vanished, AVB changed from third degree to second degree and finally to sinus rhythm. In conclusion, endomyocardial biopsy is valuable in the diagnosis of primary cardiac lymphoma. It is worth noting that alterations in the electrocardiogram may indicate an attack on the heart by PCTL.
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Affiliation(s)
- Panpan Chen
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory for Cancer Molecular Cell Biology, Life Sciences Institute, Zhejiang University, Hangzhou, China
| | - Yuanyuan Hao
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory for Cancer Molecular Cell Biology, Life Sciences Institute, Zhejiang University, Hangzhou, China
| | - Xi Qiu
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory for Cancer Molecular Cell Biology, Life Sciences Institute, Zhejiang University, Hangzhou, China
| | - Xibin Xiao
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory for Cancer Molecular Cell Biology, Life Sciences Institute, Zhejiang University, Hangzhou, China
| | - Wei Zhu
- Department of Cardiology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Provincial Key Laboratory of Cardiovascular Research, Hangzhou, China
| | - Yang Xu
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory for Cancer Molecular Cell Biology, Life Sciences Institute, Zhejiang University, Hangzhou, China
| | - Wenbin Qian
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory for Cancer Molecular Cell Biology, Life Sciences Institute, Zhejiang University, Hangzhou, China
- *Correspondence: Wenbin Qian,
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18
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Schmiester M, Tranter E, Lorusso A, Blaschke F, Geisel D, Bullinger L, Damm F, Na IK. Acute left ventricular insufficiency in a Burkitt Lymphoma patient with myocardial involvement and extensive local tumor cell lysis: a case report. BMC Cardiovasc Disord 2022; 22:31. [PMID: 35120455 PMCID: PMC8815241 DOI: 10.1186/s12872-022-02480-5] [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: 11/25/2021] [Accepted: 01/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background Burkitt lymphoma (BL) is a rare disease with the sporadic variant accounting for less than 1% of adult non-Hodgkin lymphomas. BL usually presents with an abdominal bulk, but extranodal disease affecting the bone marrow and central nervous system is common. Cardiac manifestations, however, are exceedingly rare, with less than 30 cases reported in the literature. Case presentation We report on a 54-year-old male patient with a six week-long history of paranasal sinus swelling, fatigue and dyspnea on exertion. Stage IV sporadic BL with extensive lymphonodal and cardiovascular involvement was diagnosed. Manifestations included supra- and infradiaphragmatic lymphadenopathy as well as infiltration of the aortic root, the pericardium, the right atrium and the right ventricle. EBV-reactivation was detected, which is uncommon in the sporadic subtype. After initial full-dose chemotherapy with very good BL control, the patient developed acute, but fully reversible cardiac insufficiency. Myocardial lymphoma involvement receded completely during the following two therapy cycles, while cardiac function periodically deteriorated shortly after chemotherapy administration and quickly recovered thereafter. Interestingly, the decline in cardiac function lessened with decreasing myocardial lymphoma manifestation. Once the cardiovascular BL infiltration was resolved, cardiac function remained stable throughout further treatment. Following seven cycles of chemotherapy and mediastinal radiation, the patient is now in continued complete remission. Conclusions Although rare, cardiac involvement in BL can quickly become life-threatening due to rapid lymphoma doubling time and should therefore be considered at initial diagnosis. This case suggests an association between myocardial infiltration, chemotherapy associated tumor cell lysis and transient deterioration of cardiac function until the damage caused by the underlying lymphoma could be restored. While additional studies are needed to further elucidate the mechanisms of acute cardiac insufficiency due to lymphoma lysis in the infiltrated structures, prompt BL control and full recovery of the patient supports courageous treatment start despite extensive cardiovascular involvement.
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Affiliation(s)
- Maren Schmiester
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Eva Tranter
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alessandro Lorusso
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Florian Blaschke
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lars Bullinger
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frederik Damm
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Il-Kang Na
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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19
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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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20
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Hérnandez Jimenez CA, Schlie Villa W, Ordinola Navarro A. Cardiac Burkitt's lymphoma presenting with heart failure. QJM 2021; 114:589-590. [PMID: 33713134 DOI: 10.1093/qjmed/hcab053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- C A Hérnandez Jimenez
- Department of Internal Medicine, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Centro Médico Nacional La Raza del Instituto Mexicano del Seguro Social, Calle Seris y Zaachila, La Raza, 02990 Azcapotzalco, Mexico City, Mexico
| | - W Schlie Villa
- Department of Internal Medicine, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Centro Médico Nacional La Raza del Instituto Mexicano del Seguro Social, Calle Seris y Zaachila, La Raza, 02990 Azcapotzalco, Mexico City, Mexico
| | - A Ordinola Navarro
- Department of Internal Medicine, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Centro Médico Nacional La Raza del Instituto Mexicano del Seguro Social, Calle Seris y Zaachila, La Raza, 02990 Azcapotzalco, Mexico City, Mexico
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21
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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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22
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Zhang Z, Wang S, Liang Q, Peng D. Progressive Heart Failure and Death as the Initial Manifestation of NK/T-Cell Lymphoma: A Case Report and Literature Review. Front Cardiovasc Med 2021; 8:685736. [PMID: 34250042 PMCID: PMC8264061 DOI: 10.3389/fcvm.2021.685736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
Natural killer/T-cell (NK/T-cell) lymphoma is a rare-type non-Hodgkin lymphoma derived from NK cells or cytotoxic T cells. Here, we present a case of a 40-year-old woman who experienced quick-developed global heart failure and then was diagnosed with NK/T-cell lymphoma through lymphoid biopsy. Neither transthoracic echocardiography nor any radiological images detected a mass in her heart or pericardium. Elevated plasma troponin level and diffused patchy areas of gadolinium late enhancement on cardiac magnetic resonance were compatible with myocarditis. Considering the persistently elevated cytokine level, systemic inflammation symptoms, acute respiratory distress syndrome, and cardiac dysfunction, a cytokine storm secondary to NK/T-cell lymphoma was considered. Due to the refractory malignant arrhythmia, the patient died soon after being admitted to our hospital.
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Affiliation(s)
- Ziyu Zhang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuai Wang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qingchun Liang
- Department of Pathology, The Second Xiangya Hospital, Central South Univerisity, Changsha, China
| | - Daoquan Peng
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
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23
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Chango Azanza JJ, Vredenburgh J. An Unusual Hodgkin's Lymphoma Journey: Cardiac Tamponade, Primary Refractoriness, Immune Thrombocytopenia, and Post-Traumatic Stress Disorder. Cureus 2021; 13:e15341. [PMID: 34235020 PMCID: PMC8242271 DOI: 10.7759/cureus.15341] [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] [Accepted: 05/29/2021] [Indexed: 11/18/2022] Open
Abstract
Hodgkin’s lymphoma (HL) is a lymphoid neoplasm in which malignant Hodgkin or Reed-Sternberg cells are present in tissues mixed with heterogeneous non-malignant inflammatory cells. Pericardial effusion (PEEF) in HL is rare. Furthermore, hemodynamically significant effusions causing cardiac tamponade (CTp) are exceedingly uncommon. CTp as the initial presentation of HL is extremely rare. We describe the case of a 21-year-old man who presented with CTp requiring pericardiocentesis. On further workup, he was found to have a large mediastinal mass with a biopsy consistent with classic HL. His clinical course was complicated by the development of immune thrombocytopenia (ITP) and post-traumatic stress disorder (PTSD).
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Affiliation(s)
| | - James Vredenburgh
- Hematology and Oncology, St. Francis Hospital and Medical Center, Hartford, USA
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24
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Lucchini E, Merlo M, Ballerini M, Porcari A, Sinagra G, Pagnan L, Rensi M, Romano A, Bussani R, Ballotta L, Zaja F. Case Report: Cardiac Involvement by Lymphoma: Rare but Heterogeneous Condition With Challenging Behaviors. Front Oncol 2021; 11:665736. [PMID: 33987101 PMCID: PMC8112198 DOI: 10.3389/fonc.2021.665736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/18/2021] [Indexed: 11/24/2022] Open
Abstract
Cardiac lymphomas are rare extranodal lymphomas involving primarily and secondarily the heart and/or pericardium. Here we describe three cases of cardiac involvement from lymphoma with specific peculiarities: two primary cardiac Diffuse Large B-cell Lymphomas and one secondary involvement from Marginal Zone Lymphoma (MZL). The first case highlights the issue of early CNS relapse and the possible role for CNS prophylaxis; the second case demonstrates the difficulties of interpretation and possible mistakes of different radiologic techniques adopted to evaluate cardiac involvement by lymphoma during follow-up; the third is a unique case of MZL with cardiac involvement. Our aim is to share the findings observed in these cases putting them in relation with data from the literature.
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Affiliation(s)
- Elisa Lucchini
- S.C. Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Marco Merlo
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.,Dipartimento di Scienze Mediche e Chirurgiche e della Salute (DSM), Università degli Studi, Trieste, Italy
| | - Mario Ballerini
- S.C. Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Aldostefano Porcari
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Gianfranco Sinagra
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Centro per la Diagnosi e Cura delle Cardiomiopatie, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.,Dipartimento di Scienze Mediche e Chirurgiche e della Salute (DSM), Università degli Studi, Trieste, Italy
| | - Lorenzo Pagnan
- S.C. Radiologia diagnostica ed Interventistica, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Marco Rensi
- S.C. Medicina Nucleare, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Andrea Romano
- S.C. (UCO) Anatomia ed Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Rossana Bussani
- Dipartimento di Scienze Mediche e Chirurgiche e della Salute (DSM), Università degli Studi, Trieste, Italy.,S.C. (UCO) Anatomia ed Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Laura Ballotta
- S.C. Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Francesco Zaja
- S.C. Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.,Dipartimento di Scienze Mediche e Chirurgiche e della Salute (DSM), Università degli Studi, Trieste, Italy
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25
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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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26
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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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27
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Henn MC. Commentary: Don't mess with primary cardiac lymphoma. J Thorac Cardiovasc Surg 2020; 164:582-583. [PMID: 33036751 DOI: 10.1016/j.jtcvs.2020.09.049] [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: 09/11/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Matthew C Henn
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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28
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Guimarães JP, Trigo J, Fonçalves F, Moreira JI. ST-segment elevation in a patient with cardiac lymphoma. Neth Heart J 2020; 28:496-497. [PMID: 31758494 PMCID: PMC7431511 DOI: 10.1007/s12471-019-01345-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- J P Guimarães
- Cardiology Department, Tras-os-Montes and Alto Douro Hospital Centre, Vila Real, Portugal.
| | - J Trigo
- Cardiology Department, Tras-os-Montes and Alto Douro Hospital Centre, Vila Real, Portugal
| | - F Fonçalves
- Cardiology Department, Tras-os-Montes and Alto Douro Hospital Centre, Vila Real, Portugal
| | - J I Moreira
- Cardiology Department, Tras-os-Montes and Alto Douro Hospital Centre, Vila Real, Portugal
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29
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Xiao M, Lin J, Xiao T, Lin Y, Ye Y. The incidence and survival outcomes of patients with primary cardiac lymphoma: A SEER-based analysis. Hematol Oncol 2020; 38:334-343. [PMID: 32311106 DOI: 10.1002/hon.2741] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/28/2020] [Accepted: 04/14/2020] [Indexed: 12/12/2022]
Abstract
This study aimed to evaluate the incidence and prognosis of primary cardiac lymphoma (PCL) by using the Surveillance, Epidemiology, and End Results Program (SEER) database. Patients diagnosed with PCL and the disease incidence in the SEER database from 1975 to 2016 were included. Overall survival (OS) and cause-specific survival (CSS) curves were calculated using the Kaplan-Meier method and compared by the log-rank test. Univariate and multivariable Cox proportional hazard regression analyses were used to identify associations with outcome measures. The incidence of PCL was 0.011/100 000, and a predominance of elderly and male patients was observed. A total of 144 patients were enrolled. The median age of onset was 68 (9-96) years, including 80 (55.6%) males and 64 (44.4%) females. Multivariate analysis revealed that age and chemotherapy were independent prognostic factors for OS (both P < .05). Ann Arbor stage and chemotherapy were independent prognostic factors for CSS (both P < .05). In terms of treatment modality, chemotherapy combined with surgery was an independent protective factor for OS and CSS (both P < .05). For patients with primary cardiac diffuse large B-cell lymphoma (cardiac DLBCL), multivariate analysis also showed that age, Ann Arbor stage, and chemotherapy were all independent prognostic factors for OS and CSS (all P < .05). Chemotherapy combined with surgery was associated with a significant benefit in terms of OS and CSS (both P < .05). Our study confirmed that older age and advanced Ann Arbor stage were independent risk factors for PCL, and treatment with chemotherapy or cooperation with surgery resulted in better long-term survival.
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Affiliation(s)
- Min Xiao
- Department of Intensive Care Unit, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Junpeng Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Tingting Xiao
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yan Lin
- Department of Intensive Care Unit, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Yong Ye
- Department of Intensive Care Unit, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
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30
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MYC/BCL2/BCL6 triple hit lymphoma of the pericardium: a case report and review of the literature. J Cancer Res Clin Oncol 2020; 146:2435-2438. [PMID: 32025812 DOI: 10.1007/s00432-020-03137-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/22/2020] [Indexed: 02/08/2023]
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31
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Primary Mediastinal Nodal and Extranodal Non-Hodgkin Lymphomas: Current Concepts, Historical Evolution, and Useful Diagnostic Approach: Part 1. Adv Anat Pathol 2019; 26:346-370. [PMID: 31567132 DOI: 10.1097/pap.0000000000000249] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Primary mediastinal non-Hodgkin lymphomas (PM-NHLs) represent ~5% of all NHLs and comprise lymphomas of B-cell and T-cell origin. PM-NHLs are defined as involvement of mediastinal lymph nodes, thymus, and/or mediastinal organs (heart, lung, pleura, pericardium) by NHL without evidence of systemic disease at presentation. The clinical scenario is variable and depends on the lymphoma subtype. The radiologic presentation is also variable ranging from a mediastinal mass with or without superior vena cava syndrome, a pleural or a cardiac mass associated with an effusion, or as an effusion only. The diagnosis of PM-NHLs can only be established by microscopic evaluation, and therefore, general pathologists should be aware of these tumors and familiar with their diagnostic approach. The most common anterior mediastinal NHLs (90% to 95%) are primary mediastinal large B-cell lymphoma and T lymphoblastic lymphoma. Thymic marginal zone lymphoma and mediastinal gray zone lymphoma are very rare. The remainder PM-NHLs involving middle or posterior mediastinum include diffuse large B-cell lymphoma (DLBCL) and rare cases of T-cell lymphoma, including anaplastic large cell lymphoma and breast implant-associated anaplastic large cell lymphoma extending to the anterior mediastinum. Primary pleural and cardiac NHLs are mostly DLBCLs. Other rare subtypes of PM-NHLs include DLBCL associated with chronic inflammation/pyothorax-associated lymphoma, fibrin-associated DLBCL (both EBV), and pleural and/or pericardial primary effusion lymphoma (HHV-8/EBV). We review the historical aspects, epidemiology, clinico-radiologic features, histopathology, immunohistochemistry, differential diagnosis, and relevant cytogenetic and molecular features of PM (thymic) LBCL, PM "nonthymic" DLBCL, BCL, unclassifiable, with features intermediate between DLBCL and classic Hodgkin lymphoma (mediastinal gray zone lymphoma), DLBCL associated with chronic inflammation (pyothorax-associated lymphoma), fibrin-associated DLBCL, and primary effusion lymphoma. This review represents the first part of 2 manuscripts covering PM-NHLs.
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32
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Tang WQ, Zhou H, Xiao L, Li YJ. [An anaplastic cardiac large cell lymphoma: a cases report and literatures review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:858-861. [PMID: 31775488 PMCID: PMC7364973 DOI: 10.3760/cma.j.issn.0253-2727.2019.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Indexed: 11/16/2022]
Affiliation(s)
- W Q Tang
- Department of Hematology and Lymphoma, Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China; Department of Histology and Embryology, School of Basic Medical Science, Central South University, Changsha 410083
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33
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Thayaparan AS, Haikerwal D. Eighty-nine-year-old woman with fatigue and reduced appetite. Heart 2019; 105:880-892. [PMID: 31092679 DOI: 10.1136/heartjnl-2019-314780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/03/2019] [Accepted: 03/11/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Deepak Haikerwal
- Cardiology, Western Private Hospital, Footscray, Victoria, Australia.,Cardiology, Western Health, Footscray, Victoria, Australia
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34
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Al-Mehisen R, Al-Mohaissen M, Yousef H. Cardiac involvement in disseminated diffuse large B-cell lymphoma, successful management with chemotherapy dose reduction guided by cardiac imaging: A case report and review of literature. World J Clin Cases 2019; 7:191-202. [PMID: 30705895 PMCID: PMC6354095 DOI: 10.12998/wjcc.v7.i2.191] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/26/2018] [Accepted: 01/04/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Secondary cardiac involvement by lymphoma has received limited attention in the medical literature, despite its grave prognosis. Although chemotherapy improves patients’ survival, a subgroup of treated patients dies suddenly due to myocardial rupture following chemotherapy initiation. Reducing the initial chemotherapy dose with dose escalation to standard doses may be effective in minimizing this risk but the data are limited. We report on the successful management of a patient with disseminated diffuse large B-cell lymphoma (DLBCL) involving the heart using such approach.
CASE SUMMARY An 18-year-old male presented to our hospital with six months history of progressive dyspnea, orthopnea and cough. On physical examination, the patient was found to have a plethoric and mildly edematous face, fixed elevation of the right internal jugular vein, suggestive of superior vena cava obstruction, and a pelvic mass. Investigations during admission including a thoracoabdominal computed tomography (CT) scan with CT guided biopsy of the pelvic mass, echocardiography and cardiac magnetic resonance imaging led to the diagnosis of disseminated DLBCL with cardiac involvement. The patients were successfully treated with chemotherapy dose reduction followed by dose escalation to standard doses, under the guidance of cardiac imaging. The patient completed chemotherapy and underwent a successful bone marrow transplant. He is currently in remission and has a normal left ventricular function.
CONCLUSION Imaging-guided chemotherapy dosing may minimize the risk of myocardial rupture in cardiac lymphoma. Data are limited. Management should be individualized.
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Affiliation(s)
- Rabah Al-Mehisen
- Department of Cardiology, Security Forces Hospital, Riyadh 11481, Saudi Arabia
| | - Maha Al-Mohaissen
- Department of Clinical Sciences (Cardiology), Princess Nourah Bint Abdulrahman University Research Chair in Cardiovascular Disease in Women, Princess Nourah Bint Abdulrahman University, Riyadh 11511, Saudi Arabia
| | - Hisham Yousef
- Department of Internal Medicine, Division of Hematology/Oncology, Security Forces Hospital, Riyadh 11481, Saudi Arabia
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35
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Giudicatti LC, Cirillo M, King B. Pericardial effusion as first presentation of disseminated non-Hodgkin's lymphoma. BMJ Case Rep 2018; 2018:bcr-2018-225926. [PMID: 30287628 DOI: 10.1136/bcr-2018-225926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A 46-year-old woman with quiescent lupus presented with worsening pleuritic chest pain and dyspnoea. Bedside echocardiogram confirmed large pericardial effusion with cardiac tamponade. Emergency bedside pericardiocentesis was performed. Pericardial fluid cytology confirmed diffuse large B cell lymphoma, stage four on positron emission tomography. Conventional rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone chemotherapy achieved good response in all sites except the pericardium. Progressive cardiac involvement was complicated by atrioventricular conduction block requiring permanent pacemaker. Second-line palliative chemotherapy was performed.
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Affiliation(s)
| | - Melita Cirillo
- Department of Haematology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Benjamin King
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
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36
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Higgins AY, Taylor EP, Baldassarre LA, Miller EJ, Rosenfeld LE. Diagnosis of extensive myocardial infiltration by diffuse large B-cell lymphoma using 18F-fluorodeoxyglucose positron emission tomography (18-FDG PET). J Nucl Cardiol 2018; 25:1869-1871. [PMID: 29116563 DOI: 10.1007/s12350-017-1099-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Angela Y Higgins
- Section of Cardiovascular Medicine, Yale University School of Medicine, 789 Howard Avenue Dana 3, New Haven, CT, 06510, USA
| | - Emily Pinto Taylor
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Lauren A Baldassarre
- Section of Cardiovascular Medicine, Yale University School of Medicine, 789 Howard Avenue Dana 3, New Haven, CT, 06510, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Yale University School of Medicine, 789 Howard Avenue Dana 3, New Haven, CT, 06510, USA
| | - Lynda E Rosenfeld
- Section of Cardiovascular Medicine, Yale University School of Medicine, 789 Howard Avenue Dana 3, New Haven, CT, 06510, USA.
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37
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Katagiri S, Akahane D, Suguro T, Furuya N, Fujimoto H, Saito T, Yamashita J, Nakamura N, Ohyashiki K. Cardiac biopsy with intracardiac echocardiographic guidance for successful diagnosis of cardiac lymphoma. Clin Case Rep 2018; 6:1681-1683. [PMID: 30214741 PMCID: PMC6132102 DOI: 10.1002/ccr3.1699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/06/2018] [Accepted: 06/17/2018] [Indexed: 11/16/2022] Open
Abstract
The diagnosis and appropriate treatment of cardiac lymphoma are often delayed by the difficulty in obtaining heart tissue biopsies. Intracardiac echocardiography-guided biopsy can improve the prognosis of cardiac lymphoma by decreasing postbiopsy complications and increasing biopsy quality, allowing collection of sufficient material for multilateral analysis.
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Affiliation(s)
| | - Daigo Akahane
- Department of HematologyTokyo Medical UniversityTokyoJapan
| | - Tamiko Suguro
- Department of HematologyTokyo Medical UniversityTokyoJapan
| | - Nahoko Furuya
- Department of HematologyTokyo Medical UniversityTokyoJapan
| | | | - Tetsushi Saito
- Department of CardiologyTokyo Medical UniversityTokyoJapan
| | - Jun Yamashita
- Department of CardiologyTokyo Medical UniversityTokyoJapan
| | - Naoya Nakamura
- Department of PathologyTokai University School of MedicineKanagawaJapan
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38
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Ho N, Myles JL, Johnston DR, Eicher DM, Kwon DH, Klein AL, Collier P. Pericardial Involvement with Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: A Rare Case of Constrictive Pericarditis. ACTA ACUST UNITED AC 2018; 2:147-150. [PMID: 30140781 PMCID: PMC6104145 DOI: 10.1016/j.case.2018.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CLL/SLL can involve the pericardium and may present as constrictive pericarditis. Echocardiography and cardiac MRI can aid in diagnosing constrictive pericarditis. Radical pericardiectomy is a treatment option for malignant pericardial involvement.
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Affiliation(s)
- Natalie Ho
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jonathan L Myles
- Department of Pathology, Robert J. Tomsich Institute of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Douglas R Johnston
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Donald M Eicher
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
| | - Deborah H Kwon
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Allan L Klein
- Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Patrick Collier
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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39
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40
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Kaiafa G, Bobos M, Savopoulos C, Koutsokostas T, Kouskouras K, Kalogera-Fountzila A, Zaraboukas T, Kostopoulos I, Perifanis V, Fotiadis S, Hadjimiltiades S. Heart and lymphoma: An unusual case of secondary cardiac lymphoma manifested through presyncope and syncope episodes and atrial flutter. Hellenic J Cardiol 2017; 59:182-185. [PMID: 29247778 DOI: 10.1016/j.hjc.2017.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/10/2017] [Accepted: 09/19/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Georgia Kaiafa
- First Propedeutic Department of Internal Medicine AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Mattheos Bobos
- Department of Pathology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theocharis Koutsokostas
- First Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Kostas Kouskouras
- Department of Radiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna Kalogera-Fountzila
- Department of Radiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Zaraboukas
- Department of Pathology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kostopoulos
- Department of Pathology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilis Perifanis
- First Propedeutic Department of Internal Medicine AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyros Fotiadis
- First Propedeutic Department of Internal Medicine AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Hadjimiltiades
- First Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
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41
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Annibali O, Nenna A, Barbato R, Chello M, Sedati P, Bianchi A, Deda G, Avvisati G. Primary cardiac MYC/BCL6 double hit non-Hodgkin lymphoma. J Cardiol Cases 2017; 17:103-106. [PMID: 30279867 DOI: 10.1016/j.jccase.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/01/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022] Open
Abstract
Cardiac and pericardial involvement by malignant lymphoma is a rare condition. The present case report describes a case of primary cardiac MYC/BCL6 double hit non-Hodgkin lymphoma in the pericardium, and highlights the importance of a prompt diagnosis and aggressive pharmacologic treatment of this disease. In a symptomatic patient, a minimally invasive 3 cm sub-xiphoidal incision was performed under deep sedation with spontaneous ventilation to perform a pericardial biopsy. A 5 cm × 3 cm portion of pericardium was removed from above the right ventricle, thus ameliorating the extrinsic compression on the right chambers. The patient received 6 cycles of immuno-chemotherapy (rituximab plus cyclophosphamide, vincristine, and methylprednisolone), with no complications, achieving complete remission with no symptoms. Malignancies must be excluded in every case of acute pericardial disease with imaging techniques, and lymphomas should be always considered in the differential diagnosis of cardiac tumors. Complete surgical removal of the tumor is not necessary to achieve complete remission, and minimally invasive surgical approaches are an effective tool to confirm diagnosis and allow a precise histologic characterization. <Learning objective: Primary MYC/BCL6 double hit non-Hodgkin lymphoma is a rare tumor of the pericardium, which requires prompt diagnosis and treatment. Minimally invasive surgical approaches are an effective tool to confirm diagnosis and allow a precise histologic characterization. Pericardial tumors should always be considered in the differential diagnosis of acute pericardial disease presenting with pericardial effusion. Double hit diffuse large B cell-lymphoma has a poor prognosis with standard chemotherapy and the treatment should be tailored according to the patient's comorbidities and performance status.>.
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Affiliation(s)
- Ombretta Annibali
- Unit of Hematology, Stem Cell Transplantation, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Antonio Nenna
- Unit of Heart Surgery, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Raffaele Barbato
- Unit of Heart Surgery, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Massimo Chello
- Unit of Heart Surgery, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Pietro Sedati
- Unit of Anatomical Pathology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Antonella Bianchi
- Unit of Diagnostic Imaging, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giuseppe Deda
- Unit of Diagnostic Imaging, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giuseppe Avvisati
- Unit of Hematology, Stem Cell Transplantation, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
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42
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Pirzada A, Connors S, Harris S, Adams C. Primary Cardiac T Cell Lymphoma Mimicking ST-Elevation Myocardial Infarction. Cardiology 2017; 138:259-263. [PMID: 28950259 DOI: 10.1159/000479676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/24/2017] [Indexed: 11/19/2022]
Abstract
Primary cardiac T cell lymphoma is an extremely rare condition with only a handful of biopsy-proven cases worldwide. We present a 62-year-old female presenting with nonspecific chest discomfort, shortness of breath, and anterolateral ST-elevation on electrocardiogram mimicking a ST-elevation myocardial infarction. Imaging revealed a cardiac mass and cardiac catheterization showed diffuse noncritical coronary disease with an occluded 2nd diagonal branch. Biopsy via minimally invasive cardiac surgery showed a pathologically proven diagnosis of primary cardiac T cell lymphoma. To our knowledge, this is the first documented case worldwide of primary cardiac T cell lymphoma that has resulted in ST-elevation mimicking a myocardial infarction.
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Affiliation(s)
- Ashar Pirzada
- Department of Internal Medicine, Memorial University, St. John's, NL, Canada
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43
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Lau L, Mozolevska V, Kirkpatrick IDC, Jassal DS, Kansara R. Diffuse large B-cell lymphoma mimicking cardiac amyloidosis. Clin Case Rep 2017; 5:1034-1035. [PMID: 28588865 PMCID: PMC5458038 DOI: 10.1002/ccr3.948] [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: 02/27/2017] [Revised: 03/09/2017] [Accepted: 03/14/2017] [Indexed: 11/10/2022] Open
Abstract
Our case highlights that cardiac lymphoma may mimic amyloid infiltration of the myocardium on cardiac magnetic resonance (CMR), and is a particularly challenging diagnosis in the setting of transformed Waldenström's macroglobulinemia. Heightened suspicion and early diagnosis of cardiac lymphoma is paramount as chemotherapy has been demonstrated to portent an increased survival rate.
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Affiliation(s)
- Lawrence Lau
- Section of Cardiology Department of Internal Medicine University of Manitoba Winnipeg Manitoba Canada
| | - Viktoriya Mozolevska
- Section of Cardiology Department of Internal Medicine University of Manitoba Winnipeg Manitoba Canada
| | | | - Davinder S Jassal
- Section of Cardiology Department of Internal Medicine University of Manitoba Winnipeg Manitoba Canada.,Department of Radiology University of Manitoba Winnipeg Manitoba Canada.,Section of Hematology and Medical Oncology Department of Internal Medicine University of Manitoba Winnipeg Manitoba Canada
| | - Roopesh Kansara
- Section of Hematology and Medical Oncology Department of Internal Medicine University of Manitoba Winnipeg Manitoba Canada
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44
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Cadavid L, Sastoque JM, Gutiérrez C, Yabur M, Molina G. Primary osseous Burkitt lymphoma with nodal and intracardiac metastases in a child. Radiol Case Rep 2017; 12:185-190. [PMID: 28228907 PMCID: PMC5310541 DOI: 10.1016/j.radcr.2016.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 12/16/2022] Open
Abstract
Burkitt lymphoma (BL) is the most frequent non-Hodgkin lymphoma in pediatric patients, accounting for approximately 34% of the cases of lymphoma in children. This subtype of non-Hodgkin lymphoma was first described in 1958 as a monoclonal proliferation of B cell lymphocytes. Cardiac involvement of BL in association with osseous compromise and lymphadenopathy is rare and poorly documented. We report a case of femur primary BL in an 8-year-old boy with metastatic cardiac involvement, retroperitoneal and iliofemoral lymphadenopathy, and hepatosplenomegaly. We highlight the diagnostic challenge in a patient with clinical nonspecific findings and systemic disease.
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Affiliation(s)
- Lina Cadavid
- Departments of Pediatric Radiology, Pediatric Cardiology and Oncological Orthopedics, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | | | | | - Mirna Yabur
- Departments of Pediatric Radiology, Pediatric Cardiology and Oncological Orthopedics, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Gustavo Molina
- Departments of Pediatric Radiology, Pediatric Cardiology and Oncological Orthopedics, Hospital Pablo Tobón Uribe, Medellín, Colombia
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45
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Zdrenghea M, Bagacean C, Renaudineau Y, Salaun PY, Marin H, Pop D, Tempescul A. Isolated Cardiac Richter Syndrome: a Case Report. Ann Hematol 2016; 96:147-149. [PMID: 27696201 DOI: 10.1007/s00277-016-2834-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/19/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Mihnea Zdrenghea
- Iuliu Hatieganu University of Medicine and Pharmacy, 8 Babes Street, 400012, Cluj-Napoca, Romania. .,Ion Chiricuta Institute of Oncology, 34-36 Republicii Street, 400015, Cluj-Napoca, Romania. .,Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 73, 21 Decembrie str, 400124, Cluj-Napoca, Romania.
| | - Cristina Bagacean
- Iuliu Hatieganu University of Medicine and Pharmacy, 8 Babes Street, 400012, Cluj-Napoca, Romania.,Laboratory of Immunology and Immunotherapy, CHRU Morvan, 5 Foch Avenue, 29609, Brest, France
| | - Yves Renaudineau
- Laboratory of Immunology and Immunotherapy, CHRU Morvan, 5 Foch Avenue, 29609, Brest, France
| | - Pierre-Yves Salaun
- Nuclear Medicine Department, University Hospital, 5 Foch Avenue, 29609, Brest, France
| | - Horia Marin
- Department of Radiology, Neuroscience Institute, Henry Ford Health System, Detroit, MI, USA
| | - Dana Pop
- Iuliu Hatieganu University of Medicine and Pharmacy, 8 Babes Street, 400012, Cluj-Napoca, Romania
| | - Adrian Tempescul
- Department of Hematology, CHRU Morvan, 2 Foch Avenue, 29200, Brest, France
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