Review ArticleCardiac lymphoma with early response to chemotherapy: A case report and review of the literature
Introduction
Malignant neoplasm, such as sarcomas and primary lymphomas, is very rare. In fact, almost three out of four cardiac masses are benign tumors.1 However, metastatic invasion of the heart is quite frequent.2
Cardiac involvement in case of lymphoma is commonly clinically silent and often discovered post-mortem.2 Nonetheless, some patients may complain symptomatic manifestations.2,3
Although the modern combination schemes of chemotherapy, the general prognosis of primary or secondary cardiac lymphomas is usually poor, partly because of diagnostic delay.3,4 So, it is crucial to suspect and detect early cardiac involvement, especially with the support of imaging techniques. Echocardiography is the method of choice to detect cardiac involvement and complications.5
In this case report, we present an unusual case of massive cardiac infiltration due to mediastinal lymphoma, where the multidisciplinary approach in the diagnostic phase and during the first cycle of chemotherapy has been of primary relevance. The close imaging follow-up and the efficacy of hematologic therapies have been crucial to avoid potential life-threatening complications.
Section snippets
Case Report
On May 2020, a 54-year-old man came to our attention in order to undergo surgical ablation of persistent atrial fibrillation. He was symptomatic for palpitation, dyspnea, and mild chest oppression.
During the previous year, the patient had multiple episodes of atrial fibrillation and he was also hospitalized for pericardial effusion causing cardiac tamponade and for intraparenchymal cerebral hemorrhage which necessitated surgical evacuation. In that occasion, the pericardiocentesis revealed
Discussion
This case reflects many features of the secondary cardiac lymphoma.
Primary cardiac lymphoma (PCL) is a non-Hodgkin lymphoma which involves primarily the heart and/or the pericardium, with the bulk of the tumor intrapericardial.6 Unlike PCL, secondary cardiac localization accounts for 25% of all disseminated lymphoma.3
The most prevalent secondary lymphomas are B-cell origin non-Hodgkin lymphomas, and diffuse large B-cell is the most frequent (80%). It usually affects immunocompetent male
New Knowledge Gained
This review confirms that multimodal imaging assessment is crucial to diagnose cardiac lymphoma and to early detect the occurrence of complications. Since its suspect, cardiac lymphoma necessitates multidisciplinary interventions.
Conclusion
Primary cardiac lymphoma is a rare condition, while metastatic localization of lymphoma is more frequent.3 Although usually clinically silent, some non-specific symptoms may occur. In particular, our patient had electrical disturbances and sign and symptoms of congestion.
Multimodality imaging is helpful and confirmation with biopsy is mandatory. Once detected, the cardiac lymphoma necessitated early administration of chemotherapy.
The risk of complications during chemotherapy cycles is low, but
Disclosures
Doctors Bonelli, Paris, Bisegna, Milesi, Gavazzi, Giubbini, Cattaneo, Facchetti, and Faggiano have no conflicts of interest.
Funding
Open access funding provided by Università degli Studi di Brescia within the CRUI-CARE Agreement.
Doctors Bonelli, Paris, Bisegna, Milesi, Gavazzi, Giubbini, Cattaneo, Facchetti and Faggiano have no funding sources.
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