Atypical Presentation of Small Lymphocytic Lymphoma with Pericardial Effusion

Abstract

Patient: Female, 61 Final Diagnosis: Pericardial effusion secondary to CLL Symptoms: Shortness of breath Medication: — Clinical Procedure: — Specialty: Oncology Objective: Rare co-existance of disease or pathology Background: Small lymphocytic lymphoma (SLL) is a low-grade B-cell non-Hodgkin lymphoma and is the solid tumor equivalent of chronic lymphocytic leukemia (CLL) that is found in the peripheral blood. SLL typically presents with lymphadenopathy and is rarely associated with cardiac involvement. This report is of a case of lymphomatous pericardial effusion in a 61-year-old woman who presented with dyspnea. Case Report: A 61-year-old woman presented to the emergency department with a three-month history of worsening shortness of breath on exertion. Her symptoms progressed to shortness of breath at rest, with night sweats and chills. She had no weight loss. She was found to have a pericardial effusion, and an urgent pericardiocentesis was performed to prevent cardiac tamponade. Analysis of the pericardial fluid was consistent with a diagnosis of SLL. A bone marrow biopsy and a biopsy of a renal mass were consistent with a diagnosis of SLL. She was treated with rituximab and bendamustine with granulocyte-colony stimulating factor (G-CSF) support and was discharged home. Conclusions: A case is presented of a rare association between SLL and pericardial effusion with a favorable outcome following urgent pericardiocentesis to prevent cardiac tamponade followed by chemotherapy.

Cardiac Involvement in Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

“…However, cardiac lymphoma is easily missed or misdiagnosed and frequently requires multimodality cardiac imaging, including echocardiography and cardiac magnetic resonance imaging (MRI) [ 14 , 16 , 18 ]. Although echocardiography is the initial diagnostic test for pericardial effusion, MRI provides more detail for characterizing pericardium infiltration [ 22 ]. In addition, PET-CT can be useful for diagnosing and evaluating the treatment of lymphomas with cardiac changes, especially in aggressive lymphomas [ 45 , 46 ].…”

“…The epi- and pericardium had diffuse hemorrhages and infiltrates of CD20+ and CD5+ CLL cells. Nnaoma et al report the case of a 61-year-old woman with SLL and pericardial effusion [ 22 ]. Pericardiocentesis was performed to prevent cardiac tamponade.…”

Relapsed chronic lymphocytic leukemia with a cardiac mass: A case report

“…Cardiac infiltration by CLL B-cells has been shown on autopsies of CLL patients [3] . In practice, significant cardiac or pericardial involvement by SLL/CLL is extremely rare with only a few case reports in literature [4] , [5] , [6] .…”