Primary cardiac B-cell lymphoma with atrioventricular block and paroxysmal ventricular tachycardia

Abstract

Primary cardiac lymphoma (PCL) is very rare, and is extremely challenging to diagnose due to nonspecific symptoms. When discovered, the right atrium and ventricle are most commonly affected, while diffuse cardiac involvement is uncommon. PCL is fatal unless promptly diagnosed and treated. Herein, we present the case of a 36-year-old immunocompetent male who presented with a 5-year history of non-specific chest symptoms and was diagnosed with primary diffuse cardiac large B-cell lymphoma involving the entire heart.

Figure 1

Echocardiography before treatment (left section, A: parasternal long axis and B:parasternal short axis) revealed heterogeneous infiltration involving the aortic root, and markedly increased left and right ventricular wall thickness (*). Moderate pericardial effusion (15.2 mm) was also noted (†). Six months after treatment (right section, C: parasternal long axis and D: parasternal short axis), reduced thickening of the myocardium and resolution of pericardial effusion were noted.

Figure 2

Histological and immunohistochemical staining of the endomyocardial biopsy prior to treatment revealed atypical, intermediate to large-sized lymphoid cell infiltration in myocardium; E: Hematoxylin and eosin staining (magnification at 400×). F: anti-CD19 staining (magnification at 400×). G: anti-CD20 staining (magnification at 400×). H: anti-CD79 staining (magnification at 400×).