Primary Lymphoma of the Heart: A Case Report of Surgical Treatment and Review of the Literature

  • Shuai Liu Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
  • ChongLei Ren Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
  • Yao Wang Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China

Abstract

Background: The incidence of heart tumors is the lowest in all known tumors. Primary cardiac tumors are especially rare, with an incidence of 0.056% according to autopsy reports. The most common type is myxoma, which account for nearly 70%-80% of them. Only 10% of primary cardiac tumors are malignant, approximately 95% of which are sarcomas, whereas the primary cardiac lymphomas (PCLs) are merely 1%.

Case Presentation: The present study reported a case of PCL with bilateral renal involvement. The patient received right atrial tumor excision and cardiac pacemaker implantation because of obstruction of the right ventricular outflow tract and third degree atrioventricular (AV) block. Primary diffuse large B-cell lymphoma (DLBCL) was diagnosed through pathological examination; complete remission (CR) was achieved after timely treatment with chemotherapy and autologous peripheral blood stem
cell transplantation.

Conclusions: PCL is a very rare disease with highly malignancy. With nonspecific clinical features, the diagnosis is mainly done by histopathological and immunohistochemical staining. At the moment, the most effective treatment is chemotherapy. Palliative surgery may be necessary to correct hemodynamics when outflow is obstructed. The specific location, size, and proximity of the tumor 1ead to the prognosis. Once the cardiac conduction system was involved, electrocardiography (ECG) showed high
AV block.

References

Baikoussis NG, Papakonstantinou NA, Dedeilias P, et al. 2015. Cardiac tumors: a retrospective multicenter institutional study. J BUON 20(4):1115-23.

Basso C, Valente M, Thiene G, eds. c2013. Cardiac tumor pathology. New York: Humana Press.

Ceresoli GL, Ferreri AJ, Bucci E, Ripa C, Ponzoni M, Villa E. 1997. Primary cardiac lymphoma in immunocompetent patients: diagnostic and therapeutic management. Cancer 80(8):1497-506.

Coiffier B, Lepage E, Briere J, et al. 2002. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 346(4):235-42.

Curtsinger CR, Wilson MJ, Yoneda K. 1989. Primary cardiac lymphoma. Cancer 64(2):521-5.

Fukunaga H, Tatewaki Y, Mutoh T, et al. 2018. A case of low-grade primary cardiac lymphoma with pericardial effusion diagnosed by combined 18F-fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) imaging and effusion cytology. Am J Case Rep 19:292-5.

Ito M, Tsuchiyama J, Chinushi M, Kodama M, Aizawa Y. 2005. Transient giant negative T waves associated with cardiac involvement of diffuse large B-cell lymphoma. Circulation 112(20):e322-3.

Lam KY, Dickens P, Chan AC. 1993. Tumors of the heart. A 20 year experience with a review of 12,485 consecutive autopsies. Arch Pathol Lab Med 117(10):1027-31.

Lowenthal DA, Straus DJ, Campbell SW, Gold JW, Clarkson BD, Koziner B. 1988. AIDS-related lymphoid neoplasia. The Memorial Hospital experience. Cancer 61(11):2325-37.

Minamimoto R, Morooka M, Kubota K, et al. 2011. Value of FDG-PET/CT using unfractionated heparin for managing primary cardiac lymphoma and several key findings. J Nucl Cardiol 18(3):516-20.

Nonami A, Takenaka K, Kamezaki K, et al. 2007. Successful treatment of primary cardiac lymphoma by rituximab-CHOP and high-dose chemotherapy with autologous peripheral blood stem cell transplantation. Int J Hematol 85(3):264-6.

Petrich A, Cho SI, Billett H. 2011. Primary cardiac lymphoma: an analysis of presentation, treatment, and outcome patterns. Cancer 117(3):581-9.

Svec A, Rangaiah M, Giles M, Jaksa R, McAulay KA. 2012. EBV+ diffuse large B-cell lymphoma arising within atrial myxoma. An example of a distinct primary cardiac EBV+ DLBCL of immunocompetent patients. Pathol Res Pract 208(3):172-6.

Tanaka PY, Atala MM, Pereira J, Caterino-de-Araujo A. 2009. Primary effusion lymphoma with cardaic involvement in HIV positive patient-complete response and long survival with chemotherapy and HAART. J Clin Virol 44(1):84-85.

Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG, eds. 2015. WHO classification of tumours of the lung, pleura, thymus and heart. Lyon: IARC Press.

Wang Q, Zhu J. 2014. Diagnosis and treatment of primary cardiac lymphoma in China. J Guangxi Med 36(5):671-3.

Yoshihara S, Naito M, Tanioka F, Matsunaga M. 2013. A case of primary cardiac lymphoma: in vivo imaging and pathologic correlation. Eur Heart J Cardiovasc Imaging 14(10):1027.

Zaharia L, Gill PS. 1991. Primary cardiac lymphoma. Am J Clin 0ncol 14(2):142-5.

Zhong L, Yang S, Lei K, Jia Y. 2013. Primary cardiac lymphoma: a case report and review of the literature. Chin German J Clin Oncol 12(1):43-5.

Published
2019-05-22
Section
Articles