Primary cardiac diffuse large B-cell lymphoma presenting with cardiac tamponade: a case report

Abstract

Background Primary cardiac tumors are extremely rare with an autopsy incidence of 0.05%. They can present with a variety of symptoms, including life threatening arrhythmia and cardiac tamponade. In this case report, we focus on the diagnostic process and management of a primary cardiac lymphoma presenting with cardiac tamponade. Case summary We report on a 71-year-old male presenting with a large pericardial effusion, tamponade, and a mass in the right atrioventricular groove. Multimodality imaging was performed, including transthoracic echocardiography, computed tomography, magnetic resonance imaging, positron emission tomography and computed tomography-guided transthoracic biopsy The final diagnosis of a double-hit diffuse large cell B-cell lymphoma was made, for which treatment consisting of a combination of chemotherapy and immunotherapy was initiated. Low-dose colchicine was also added to the treatment. Discussion Primary cardiac lymphoma remains a very rare diagnosis and this case highlights the need for multimodality imaging and imaging-guided biopsy to differentiate cardiac masses. First-line treatment for primary cardiac lymphoma remains a combination of chemotherapy with immunotherapy, with addition of low-dose colchicine to prevent recurrence of malignant pericardial effusion.

Cardiac Tamponade: An Initial Manifestation of Diffuse Large B Cell Lymphoma

“…While the incidence of cardiac and pericardial involvement by lymphoma is notably rare, accounting for just 0.5% of cardiac involvements and 1% of extranodal NHL presentations, it typically occurs in male patients in their 60s [ 3 ]. In contrast, the patient in our case is an elderly woman, highlighting the atypical presentation of DLBCL with pericardial effusion and tamponade without primary bone marrow involvement [ 4 ]. This emphasizes the necessity of recognizing that DLBCL can manifest spontaneously with pericardial effusion.…”

“…Primary cardiac lymphomas are specifically defined as lymphomas confined to the heart and pericardium [ 4 ]. These malignancies typically affect the right heart, particularly the right atrium, although literature reports a few instances where the bulk of the lymphoma is located in the left heart sections [ 3 ].…”

“…In our reported case, the patient presented with a significant pericardial effusion (>2 cm) leading to cardiac tamponade, with no direct tumor involvement of the heart tissue. Diagnostic and staging procedures heavily rely on multimodality imaging, including transthoracic echocardiograms (TTE), CT scans, MRIs, and PET-CT, which are crucial for accurately characterizing these lesions [ 4 ]. Among patients with PCL, only 20% display pericardial tamponade at initial presentation, commonly presenting with symptoms such as dyspnea and arrhythmia [ 4 ].…”

Masquerade of an emergency: cardiac tamponade as a deceptive presentation of primary cardiac diffuse large b-cell lymphoma—a case report

“… 1 , 2 Cardiac lymphomas, which represent <1% of all malignant primary cardiac tumours, are even more uncommon. 3 We report a case of a patient with primary cardiac lymphoma who presented with a life-threatening tamponade which demanded immediate sternotomy. This case report highlights the importance of conducting additional diagnostic procedures, alongside multimodality imaging to procure tissue samples for pathological analysis, in the situation where a vascular-rich mass located in the heart’s left ventricle and apex resulted in cardiac tamponade necessitating sternotomy.…”