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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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Zhao Y, Huang S, Ma C, Zhu H, Bo J. Clinical features of cardiac lymphoma: an analysis of 37 cases. J Int Med Res 2021; 49:300060521999558. [PMID: 33752450 PMCID: PMC7995496 DOI: 10.1177/0300060521999558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To summarize the clinical and pathological features of patients with cardiac lymphoma. METHODS The general conditions, clinical features, pathological types, and prognostic indices of 37 patients with cardiac lymphoma treated in our hospital were analyzed. RESULTS Among the 37 patients, only one had primary cardiac lymphoma, and the other 36 patients had secondary cardiac lymphoma. The cardiac manifestations were mainly chest tightness, shortness of breath, increased heart rates, and electrocardiographic abnormality caused by pericardial effusion, but myocardial enzyme levels were normal in all patients. Only three patients displayed solid heart-occupying manifestations. These lesions were mainly located in the right atrium, and the masses were all larger than 5 cm. The pathological type was diffuse large B cell lymphoma that did not arise from the germinal center in all three patients. CONCLUSIONS Cardiac lymphoma was mostly secondary, and pericardial effusion was the primary objective sign. Moreover, cardiac lymphoma was characterized by a high international prognostic index, late stage, and high rates of T and NK cell lymphoma. Most cases were accompanied by serous cavity effusion, extranodal involvement of important organs, elevated lactate dehydrogenase levels, hypoalbuminemia, and normal myocardial enzyme levels.
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Affiliation(s)
- Yu Zhao
- Department of Hematology, First Medical Center, 104607Chinese PLA General Hospital, Beijing, China
| | - Sai Huang
- Department of Hematology, First Medical Center, 104607Chinese PLA General Hospital, Beijing, China
| | - Chao Ma
- Department of Hematology, First Medical Center, 104607Chinese PLA General Hospital, Beijing, China
| | - Haiyan Zhu
- Department of Hematology, First Medical Center, 104607Chinese PLA General Hospital, Beijing, China
| | - Jian Bo
- Department of Hematology, First Medical Center, 104607Chinese PLA General Hospital, Beijing, China
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Alfahadi MN, Malik FA, Almahlawi AS, Alhamdan WA. A rare case of the superior vena cava obstruction in a 16-year-old boy with Burkitt's lymphoma: A case report. J Taibah Univ Med Sci 2021; 16:465-469. [PMID: 34140876 PMCID: PMC8178627 DOI: 10.1016/j.jtumed.2020.12.011] [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: 11/25/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 11/24/2022] Open
Abstract
Burkitt's lymphoma (BL) is an aggressive non-Hodgkin B-cell lymphoma. Superior vena cava obstruction (SVCO) is considered a rare presentation of BL and it is usually associated with other types of non-Hodgkin lymphoma such as diffuse large-cell. We report a rare case of sporadic BL with SVCO in a 16-year-old boy with nasopharyngeal, mediastinal, and adrenal masses. The patient presented with a two-month history of left upper neck swelling that increased with time and was not associated with other symptoms. The patient tested positive for COVID-19 on the second day after admission. On examination, he had enlarged solitary lateral cervical and bilateral posterior auricular lymph nodes. There were no signs or symptoms of SVCO regardless of the findings suggested by the computed tomography of the chest. The patient was treated with hyper-CVAD chemotherapy and showed a remarkable resolution of the nasopharyngeal and mediastinal masses with a mild response of his adrenal mass. There were no complications detected during this patient's management.
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Affiliation(s)
- Mohammad N. Alfahadi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA
- Corresponding address: College of Medicine, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 7535, Riyadh, 13225, KSA.
| | - Fatima A. Malik
- Division of Internal Medicine, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, KSA
| | - Alzahraa S. Almahlawi
- Division of Internal Medicine, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, KSA
| | - Wejdan A. Alhamdan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA
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Kalisz K, Alessandrino F, Beck R, Smith D, Kikano E, Ramaiya NH, Tirumani SH. An update on Burkitt lymphoma: a review of pathogenesis and multimodality imaging assessment of disease presentation, treatment response, and recurrence. Insights Imaging 2019; 10:56. [PMID: 31115699 PMCID: PMC6529494 DOI: 10.1186/s13244-019-0733-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/13/2019] [Indexed: 12/12/2022] Open
Abstract
Burkitt lymphoma (BL) is a highly aggressive, rapidly growing B cell non-Hodgkin lymphoma, which manifests in several subtypes including sporadic, endemic, and immunodeficiency-associated forms. Pathologically, BL is classically characterized by translocations of chromosomes 8 and 14 resulting in upregulation of the c-myc protein transcription factor with upregulation of cell proliferation. BL affects nearly every organ system, most commonly the abdomen and pelvis in the sporadic form. Imaging using a multimodality approach plays a crucial role in the management of BL from diagnosis, staging, and evaluation of treatment response to therapy-related complications with ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography playing roles. In this article, we review the pathobiology and classification of BL, illustrate a multimodality imaging approach in evaluating common and uncommon sites of involvement within the trunk and head and neck, and review common therapies and treatment-related complications.
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Affiliation(s)
- Kevin Kalisz
- Department of Radiology, Duke University, Durham, NC, USA
| | - Francesco Alessandrino
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA. .,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Rose Beck
- Department of Pathology, UH Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Daniel Smith
- Department of Radiology, UH Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Elias Kikano
- Department of Radiology, UH Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Nikhil H Ramaiya
- Department of Radiology, UH Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Sree Harsha Tirumani
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, UH Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Lazkani M, Rivera-Bonilla T, Eddin M, Girotra S, Pershad A. The evanescent right atrial mass. Indian Heart J 2015; 67:485-8. [PMID: 26432743 DOI: 10.1016/j.ihj.2015.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/09/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022] Open
Abstract
An unusual cause of pulmonary emboli from an evanescent right atrial mass is described in this case report. The systematic approach from initial presentation to a definite diagnosis of a rare condition is described.
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Affiliation(s)
- Mohamad Lazkani
- Department of Cardiology, Cavanagh Heart Center, Banner University Medical Center, Phoenix, AZ 85006, USA.
| | - Tomas Rivera-Bonilla
- Department of Cardiology, Cavanagh Heart Center, Banner University Medical Center, Phoenix, AZ 85006, USA
| | - Moneer Eddin
- Department of Cardiology, Cavanagh Heart Center, Banner University Medical Center, Phoenix, AZ 85006, USA
| | - Sudhakar Girotra
- Department of Cardiology, Cavanagh Heart Center, Banner University Medical Center, Phoenix, AZ 85006, USA
| | - Ashish Pershad
- Department of Cardiology, Cavanagh Heart Center, Banner University Medical Center, Phoenix, AZ 85006, USA
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Desgranges ZP, Deubner H, Broudy VC, Chen MA. Burkitt Lymphoma of the Heart. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2011. [DOI: 10.1177/8756479311413925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The incidence of non-Hodgkin lymphoma has increased over the past 10 years, particularly in association with human immunodeficiency virus (HIV) infection. Burkitt lymphoma is a highly aggressive non-Hodgkin lymphoma that involves the heart in up to a third of cases. This case describes an HIV-positive patient with cardiac involvement of Burkitt lymphoma who presented with atrial flutter and heart failure with pulmonary edema. Transthoracic echocardiography showed extensive heterogeneous lymphomatous infiltration of the heart (including the right atrium), with associated wall motion abnormalities. Within a day of starting chemotherapy, the patient had converted to normal sinus rhythm. His heart failure rapidly improved, and a repeat echocardiogram performed on day 5 of chemotherapy showed a significant reduction in myocardial tumor burden and improved cardiac function. This case demonstrates how echocardiography plays a significant role in diagnosis, management, and follow-up of lymphoma (in this case Burkitt) with cardiac involvement.
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Affiliation(s)
- Zana P. Desgranges
- Department of Internal Medicine, Harborview Medical Center, University of Washington, Seattle, USA
| | - Heike Deubner
- Department of Pathology, Harborview Medical Center, University of Washington, Seattle, USA
| | - Virginia C. Broudy
- Department of Internal Medicine, Division of Hematology Oncology, Harborview Medical Center, University of Washington, Seattle, USA
| | - Michael A. Chen
- Department of Internal Medicine, Division of Cardiology, Harborview Medical Center, University of Washington, Seattle, USA
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O'Mahony D, Debnath I, Janik J, Aisner D, Jaffe E, Waldmann T, Morris J. Cardiac involvement with human T-cell lymphotrophic virus type-1-associated adult T-cell leukemia/lymphoma: The NIH experience. Leuk Lymphoma 2009; 49:439-46. [DOI: 10.1080/10428190701809164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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O'Mahony D, Peikarz RL, Bandettini WP, Arai AE, Wilson WH, Bates SE. Cardiac involvement with lymphoma: a review of the literature. ACTA ACUST UNITED AC 2009; 8:249-52. [PMID: 18765314 DOI: 10.3816/clm.2008.n.034] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Current literature suggests that the incidence of cardiac involvement by lymphoma as identified by autopsy varies widely, ranging from 8.7% to 20%. Historically, many cases might have been clinically undetected; however, improved imaging techniques increasingly identify cardiac involvement incidentally. In addition, newer agents resulting in improved cancer therapy outcomes might alter the prevalence and location of metastatic deposits to include more unusual disease sites, including intracardiac locations. We present 2 cases and a review of the literature.
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Affiliation(s)
- Deirdre O'Mahony
- Metabolism Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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