Elsevier

Journal of Nuclear Cardiology

Volume 29, Issue 6, December 2022, Pages 3044-3056
Journal of Nuclear Cardiology

Review Article
Cardiac lymphoma with early response to chemotherapy: A case report and review of the literature

https://doi.org/10.1007/s12350-021-02570-5Get rights and content

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.

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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