Successful Treatment of Primary Cardiac Lymphoma With Atrioventricular Nodal Block

Takenaka, Sou; Mitsudo, Kazuaki; Inoue, Katsumi; Goto, Tsuyoshi; Kadota, Kazushige; Fujii, Satoki; Yamamoto, Hiroyuki; Fuku, Yasushi; Hirono, Akitoshi; Tanaka, Hiroyuki; Taba, Masanao; Ikeda, Atsushi; Maekawa, Junpei; Maekawa, Sachiko; Takahashi, N.; Saeki, Hajime; Nakamura, Yukinobu; Oonishi, Tatsuhito; Ueda, Natsuki

doi:10.1536/ihj.46.927

Cited by 20 publications

(11 citation statements)

References 12 publications

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“…Chemotherapy, immuno-chemotherapy, stem cell transplant, radiation therapy and combined modality approaches have been used to treat PCL. 7,8,[11][12][13][14] Recent reviews have attempted to assess CR rates using these various approaches in PCL. 7,8 Traditionally, PCL is thought to have an extremely poor prognosis due to life-threatening complications, such as cardiac rupture, which can occur at diagnosis or during treatment due to the anatomical location of the tumor.…”

Section: Utility Of Multimodality Imaging In Diagnosis and Managementmentioning

confidence: 99%

Primary cardiac lymphoma: Utility of multimodality imaging in diagnosis and management

Mato

Morgans

Roullet

et al. 2007

Cancer Biology & Therapy

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Primary cardiac lymphoma (PCL) is an extremely rare disease defined as a lymphoma strictly confined to the heart or pericardium without dissemination. We present the case of an 82 yr old male with newly diagnosed PCL and two years of subsequent follow up. This report highlights the utility of a multimodality imaging approach in the diagnosis and management of PCL.An 82-year-old man with chronic atrial fibrillation presented in September 2005 with weight loss, night sweats, dyspnea, and chest pain. Transthoracic echocardiography was diagnostic of cardiac tamponade. A pericardial window was emergently placed and hemorrhagic pericardial fluid evacuated. A postoperative transthoracic echocardiogram revealed a 3.5 x 3 x 2.5 cm mass in the right atrium appearing to originate from the coronary sinus. Twelve days later, the patient underwent surgical resection of this mass (Fig. 1). Routine histopathology revealed a dense infiltrate of large malignant lymphoid cells with a brisk mitotic rate ( Fig. 2A). Immunohistochemistry showed co-expression by tumor cells of CD20 (Fig. 2B), CD79a, and BCL2 ( Fig. 2C) with weak BCL6 expression; CD5 and CD10 were not expressed. Ki-67 staining demonstrated a proliferative rate of 50% (Fig. 2D). Flow cytometric analysis of a cell suspension prepared from fresh tissue revealed a clonal population of kappa light chain restricted, large B-cells that expressed CD20 without co-expression of CD19, CD5, CD10, CD11c or CD23. These morphologic and immunophenotypic features were consistent with diffuse large B-cell lymphoma, probably of non-germinal center histogenic origin. 1,2 CT scans with IV contrast of the chest, abdomen and pelvis performed 3 days after surgery showed no pathologically enlarged lymph nodes or other evidence of lymphoma; an intracardiac mass was not identified. A combined CT / FDG-PET scan performed 10 days post-op revealed a large markedly hypermetabolic intra-atrial mass in the mid lower chest just above the level of the diaphragm without evidence of extra-cardiac involvement by lymphoma (Fig. 3). MRI examination of the heart performed 29 days post-op revealed a soft tissue mass located in the interatrial and basal interventricular septum measuring 5.6 x 3.6 x 3.6 cm with infiltration into the right atrial wall, right ventricular myocardium and basal left ventricle (Fig. 4). Laboratory data at presentation were remarkable for anemia and a mildly increased serum LDH (638 U/L; normal ≤618 U/L). The patient was diagnosed with stage IE primary cardiac lymphoma (PCL), diffuse large B-cell type (DLBCL).The patient received his first cycle of R-CHOP chemotherapy (Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) 29 days post-op. 3 Due to the patient's age and performance status, a decision was made to administer R-CHOP using a modified schedule as follows: Day 1-Rituximab 375mg/m 2 mg, doxorubicin 25 mg/m 2 , cyclophosphamide 375mg/m 2 mg, vincristine 1 mg and prednisone 50 mg daily for five days; Day 14-doxorubicin 25 mg/m 2 , cyclophosphamide 375 mg/m ...

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Section: Utility Of Multimodality Imaging In Diagnosis and Managementmentioning

confidence: 99%

Primary cardiac lymphoma: Utility of multimodality imaging in diagnosis and management

Mato

Morgans

Roullet

et al. 2007

Cancer Biology & Therapy

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“…1,3,[6][7][8] Primary cardiac lymphoma is diffi cult to diagnose clinically because of its nonspecifi c clinical manifestations. 1,3,4 Noninvasive imaging methods such as TTE, CT, and MRI have allowed early, correct detection of primary cardiac malignancies. 1,3,6,8,9 Ceresoli et al 9 reported that the sensitivities of TTE, CT, and MRI for detecting primary cardiac lymphoma were 55%, 71%, and 92%, respectively.…”

Section: Case Reportmentioning

confidence: 99%

“…1,3 Symptoms range from those mimicking angina, congestive heart failure, or pericarditis to heart block and sudden death. 1,3,4 Therefore, early and correct diagnosis is important for patient management, and radiologists should be familiar with its imaging fi ndings. We describe a case of a 76-year-old woman with a primary cardiac lymphoma who was successfully treated with surgery and chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Primary cardiac lymphoma: computed tomography and magnetic resonance imaging features

Utsunomiya¹,

Awai²,

Urata

et al. 2009

Jap J Radiol

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Primary cardiac lymphoma is a rare, extremely aggressive malignancy. Early diagnosis and treatment is important for patient survival. We present a case of a 76-year-old woman admitted for worsening dyspnea caused by a large tumor in the right atrium. Magnetic resonance imaging and computed tomography clearly depicted the primary cardiac tumor, and histopathological study of the surgical specimen confirmed the diagnosis of diffuse large B-cell lymphoma.

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“…In most cases, normal sinus rhythm with normal AV conduction can be achieved by chemotherapy, without permanent pacemaker implantation. 1,[14][15][16] In the present case, AV conduction disturbance did not resolve and permanent pacemaker implantation was necessary. The tumor location, tumor infiltration and interval of starting therapy might be affected.…”

mentioning

confidence: 99%

Primary Cardiac B-Cell Lymphoma Presented as Heart Tamponade and Atrioventricular Block

Chiba¹,

Oka²,

Saito³

et al. 2010

Acta Cytologica

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Successful Treatment of Primary Cardiac Lymphoma With Atrioventricular Nodal Block

Cited by 20 publications

References 12 publications

Primary cardiac lymphoma: Utility of multimodality imaging in diagnosis and management

Primary cardiac lymphoma: Utility of multimodality imaging in diagnosis and management

Primary cardiac lymphoma: computed tomography and magnetic resonance imaging features

Primary Cardiac B-Cell Lymphoma Presented as Heart Tamponade and Atrioventricular Block

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