Primary cardiac T cell lymphoma

Diagnosis of Primary Cardiac T-cell Lymphoma: Feasibility and Safety of Endomyocardial Biopsy Guided by Pre-acquired Cardiovascular Magnetic Resonance

Background

Multimodality imaging of a cardiac mass lesion may raise suspicion of a primitive cardiac lymphoma (PCL). However, a definitive diagnosis requires histopathological confirmation.

Methods

This report describes the methodology we used to perform biopsy sampling of a cardiac mass lesion affecting a 45-year-old man. In order to increase endomyocardial biopsy diagnostic accuracy, we used pre-acquired cardiac magnetic resonance (CMR) images to guide the bioptome on a cardiac site overtly infiltrated by the suspected tumour. The right ventricular outflow tract was identified as the target site for biopsy sampling. To reduce the risk of the procedure, the biopsy was performed at a safe distance from the tip of a diagnostic quadripolar catheter positioned at the level of the pulmonary valve, previously identified by pacing manoeuvres. The reported approach demonstrated safety and diagnostic accuracy, allowing the identification of an extremely rare PCL subtype of T-cell origin.

Conclusion

Biopsy sampling of a suspected tumour may be safely and accurately performed using pre-acquired CMR images to guide the bioptome on the target site.

LEARNING POINTS

Multimodal imaging techniques capable of tissue characterization may raise suspicion of a primary cardiac lymphoma (PCL).However, the final diagnosis of PCL can be confirmed only by histological examination of a tissue sample.Biopsy sampling of the mass lesion may be accurately guided by previously acquired cardiac magnetic resonance images.

Primary cardiac lymphoma in a 10-week-old dog

A 10-week-old miniature dachshund presented with acute onset of weakness. Electrocardiography showed sustained ventricular tachycardia, and thoracic and abdominal radiography revealed pleural and peritoneal effusion. Echocardiography revealed severely hypokinetic left and right ventricles. Thoracocentesis and abdominocentesis and subsequent transfer to an oxygen chamber yielded no clinical improvement, and the dog died about 1 hr after admission. Gross examination of a longitudinal section through the entire heart revealed poorly demarcated focal or patchy areas of grayish-white tissue infiltrating extensively into the myocardium. Histologically, these lesions were consistent with infiltrative proliferation of neoplastic lymphoid cells. Immunohistochemical staining confirmed the diagnosis of primary cardiac lymphoma (PCL) of T-cell origin. There have been no previous reports of such young dogs with PCL.

Complete AV Block and Torsades de Pointes in a Case of Primary Cardiac T-Cell Lymphoma

Primary cardiac lymphoma is very rare, and the most common electrocardiographic finding in this condition is complete atrioventricular block. After electrolytic, metabolic, ischemic, infectious, and traumatic etiologies have been excluded, primary cardiac lymphoma should be consided as a possible cause of reversible atrioventricular block. Most patients with primary cardiac lymphoma are immunocompromised and have disease with a B-cell etiology. This is the first case report of a primary cardiac T-cell lymphoma with complete atrioventricular block and torsades de pointes in an immunocompetent patient who was successfully treated using chemotherapy.

KEY WORDS

Atrioventricular block; T-cell lymphoma; Torsades de pointes.

Right-sided congestive heart failure in a dog because of a primary intracavitary myocardial lymphoma

CASE REPORT

A 9-year-old female intact Cocker Spaniel was presented with a history of acute-onset dyspnoea and abdominal distension of 3 days' duration. Ultrasonography revealed pleural, peritoneal and pericardial effusions. Abdominal fluid analysis was consistent with a modified transudate. Echocardiography revealed a large, hypoechoic space-occupying mass within the right atrium. The dog was euthanased and the postmortem examination showed a solid, 40 × 35 × 20 mm broad-based mass arising from the right atrial wall and occluding approximately 90% of the right atrial lumen. Histopathology revealed myocardial lymphoma. There were histologically similar, focal nodules in the lung parenchyma without involvement of other extracardiac sites. There was gross and histological evidence of hepatic congestion and marked distension of the caudal vena cava, consistent with secondary right-sided congestive heart failure.

CONCLUSION

This case highlights the need to consider lymphoma as a differential diagnosis for an intra-atrial mass and as a cause of congestive heart failure in the dog.