Diffuse large B cell pericardial lymphoma: a case report

    Authors

    Abstract

    **Introduction:** Diffuse large B cell lymphoma (DLBCL) is an aggressive and fast-growing type of lymphoma. Cardiac lymphoma is a rare cardiac tumor and an even more rare extranodal site of lymphoma, of which the most common type is DLBCL. (1-3) We report a case of an 85-year-old female patient with pericardial lymphoma presenting with persistent effusions. **Case report:** 85-year-old female patient presented with sudden onset chest pain and dyspnea. A week before she was diagnosed with atrial fibrillation and warfarin and bisoprolol therapy was started. Echocardiography showed a circular pericardial effusion up to 20 mm thickness with no signs of impending tamponade. Thoracic, abdominal and pelvic CT showed no pathology, apart from the effusion. Laboratory tests showed a suspected M-protein and IgM/kappa through serum protein electrophoresis. A 3-week follow-up revealed a progression in effusion volume (29 mm) and symptoms exacerbation with ankle edema, chest pain and night sweats. Cytological analysis of an effusion sample verified DLBCL with plasma cell differentiation. The same was confirmed by bone marrow biopsy. Imaging showed no signs of lymphadenopathy or hepatosplenomegaly. Lymphoma was staged as Ann Arbour IVB and IRI 3. Therapy was initiated according to the R-CEOP protocol. After 4 therapy cycles echocardiography showed no signs of effusion. A total of 8 therapy cycles were administered and a control work-up showed total remission of the disease. **Conclusion:** New therapeutic protocols for this type of aggressive lymphoma have significantly improved patient survival rates. Clinical presentation is usually unspecific with a wide differential diagnosis. Given that extranodal and cardiac involvement is a negative prognostic sign for patient survival, efforts are warranted to improve the time to diagnosis and therapy initiation necessary for a favorable outcome.

    Keywords

    lymphoma, pericardium, effusion, chemotherapy

    DOI

    https://doi.org/10.15836/ccar2018.469

    Literature

    1. Stakos DA, Xatseras DI, Boudoulas H. Cardiac lymphoma. Eur Heart J. 2006 Jul;27(13):1538. https://doi.org/10.1093/eurheartj/ehi593
    2. Petrich A, Cho SI, Billett H. Primary cardiac lymphoma. Cancer. 2011 Feb 1;117(3):581–9. https://doi.org/10.1002/cncr.25444
    3. Chen CF, Hsieh PP, Lin SJ. Primary cardiac lymphoma with unusual presentation: A report of two cases. Mol Clin Oncol. 2017 Mar;6(3):311–4. https://doi.org/10.3892/mco.2017.1131
    Cardiologia Croatica
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    Diffuse large B cell pericardial lymphoma: a case report

    Extended Abstract
    Issue11-12
    Published
    Pages469
    PDF via DOIhttps://doi.org/10.15836/ccar2018.469
    lymphoma
    pericardium
    effusion
    chemotherapy

    Authors

    Mate Zvonimir Parčina*ORCIDKlinički bolnički centar Split, Split, Hrvatska
    Mijo MeterORCIDKlinički bolnički centar Split, Split, Hrvatska
    Josip KatićORCIDKlinički bolnički centar Split, Split, Hrvatska
    Viktor BlaslovORCIDKlinički bolnički centar Split, Split, Hrvatska

    *Correspondence email: mateparcina@gmail.com

    Abstract

    **Introduction:** Diffuse large B cell lymphoma (DLBCL) is an aggressive and fast-growing type of lymphoma. Cardiac lymphoma is a rare cardiac tumor and an even more rare extranodal site of lymphoma, of which the most common type is DLBCL. (1-3) We report a case of an 85-year-old female patient with pericardial lymphoma presenting with persistent effusions. **Case report:** 85-year-old female patient presented with sudden onset chest pain and dyspnea. A week before she was diagnosed with atrial fibrillation and warfarin and bisoprolol therapy was started. Echocardiography showed a circular pericardial effusion up to 20 mm thickness with no signs of impending tamponade. Thoracic, abdominal and pelvic CT showed no pathology, apart from the effusion. Laboratory tests showed a suspected M-protein and IgM/kappa through serum protein electrophoresis. A 3-week follow-up revealed a progression in effusion volume (29 mm) and symptoms exacerbation with ankle edema, chest pain and night sweats. Cytological analysis of an effusion sample verified DLBCL with plasma cell differentiation. The same was confirmed by bone marrow biopsy. Imaging showed no signs of lymphadenopathy or hepatosplenomegaly. Lymphoma was staged as Ann Arbour IVB and IRI 3. Therapy was initiated according to the R-CEOP protocol. After 4 therapy cycles echocardiography showed no signs of effusion. A total of 8 therapy cycles were administered and a control work-up showed total remission of the disease. **Conclusion:** New therapeutic protocols for this type of aggressive lymphoma have significantly improved patient survival rates. Clinical presentation is usually unspecific with a wide differential diagnosis. Given that extranodal and cardiac involvement is a negative prognostic sign for patient survival, efforts are warranted to improve the time to diagnosis and therapy initiation necessary for a favorable outcome.

    Literature

    1. 1.
      Stakos DA, Xatseras DI, Boudoulas H. Cardiac lymphoma. Eur Heart J. 2006 Jul;27(13):1538.DOI
    2. 2.
      Petrich A, Cho SI, Billett H. Primary cardiac lymphoma. Cancer. 2011 Feb 1;117(3):581–9.DOI
    3. 3.
      Chen CF, Hsieh PP, Lin SJ. Primary cardiac lymphoma with unusual presentation: A report of two cases. Mol Clin Oncol. 2017 Mar;6(3):311–4.DOI