Clinical features of cardiac lymphoma: an analysis of 37 cases

Abstract

Objective: To summarize the clinical and pathological features of patients with cardiac lymphoma.

Methods: The general conditions, clinical features, pathological types, and prognostic indices of 37 patients with cardiac lymphoma treated in our hospital were analyzed.

Results: Among the 37 patients, only one had primary cardiac lymphoma, and the other 36 patients had secondary cardiac lymphoma. The cardiac manifestations were mainly chest tightness, shortness of breath, increased heart rates, and electrocardiographic abnormality caused by pericardial effusion, but myocardial enzyme levels were normal in all patients. Only three patients displayed solid heart-occupying manifestations. These lesions were mainly located in the right atrium, and the masses were all larger than 5 cm. The pathological type was diffuse large B cell lymphoma that did not arise from the germinal center in all three patients.

Conclusions: Cardiac lymphoma was mostly secondary, and pericardial effusion was the primary objective sign. Moreover, cardiac lymphoma was characterized by a high international prognostic index, late stage, and high rates of T and NK cell lymphoma. Most cases were accompanied by serous cavity effusion, extranodal involvement of important organs, elevated lactate dehydrogenase levels, hypoalbuminemia, and normal myocardial enzyme levels.

Keywords: B cell; Lymphoma; T cell; extranodal involvement; heart; international prognostic index; pericardial effusion.

Figure 1.

Cardiac tumor of patient 1. The patient had a low-echo mass (6.0 × 4.0 cm²) in the anterior wall of the right atrium, which was enlarged, and the mass protruded into the superior vena cava (4.2 × 2.0 cm²) and displayed poor mass mobility and a small amount of pericardial effusion.

Figure 2.

Cardiac tumor of patient 2. Patient 2 had a solid hypoechoic mass (5.0 × 3.5 cm²) adjacent to the anterior lobe of the tricuspid valve in the right atrium. There was moderate to large regurgitation of the tricuspid valve, and the right atrium was large and contained a small amount of pericardial effusion. A solid mass with an area of 3.2 × 0.9 cm² was present in the pericardial cavity of the left ventricular posterior wall.

Figure 3.

Excisional lymph node biopsy with immunohistochemistry in a patient with B cell lymphoma. A. CD20 (+++). B. Bcl-2 (+, >80%). C. Bcl-6 (+). D. Mum-1 (+). E. Ki-67 (+, >80%). F. CD10 (slightly +).

Figure 4.

Excisional lymph node biopsy with immunohistochemistry in a patient with T and NK cell lymphoma. A. CD20 (+++). B. CD3 (+++). C. CD4 (+). D. CD45RO (+++). E. EBER (+++). F. TIA1 (+).