Korean Circ J.  2012 Jan;42(1):46-49. 10.4070/kcj.2012.42.1.46.

A Butterfly-Shaped Primary Cardiac Lymphoma That Showed Bi-Atrial Involvement

• Cho JS
• Her SH
• Park MW
• Kim HD
• Baek JY
• Youn HJ
• Seung KB
• Kim JH

• KMID: 2297907
• DOI: http://doi.org/10.4070/kcj.2012.42.1.46

Abstract

We described here a patient who presented with symptoms of heart failure who was found to have severe bilateral impairment of atrioventricular inflow. Primary cardiac lymphoma (PCL) with extensive involvement of the two atria, pericardium and myocardium is an extremely rare tumor in immunocompetent patients. We report here a case of PCL in an immunocompetent patient with involvement of both atria and the atrial septum. The tumor had a butterfly shape. We could not do surgical excision because of the massive pericardiac invasion. The diagnosis was B-cell lymphoma and this was confirmed by the pericardiac biopsy.

Keyword

Lymphoma; Large B-cell, diffuse; Cardiac tumor; Heart atria; Pericardium

MeSH Terms

Atrial Septum
Biopsy
Butterflies
Heart Atria
Heart Failure
Heart Neoplasms
Humans
Lymphoma
Lymphoma, B-Cell
Myocardium
Pericardium

Figure

• 

  Fig. 1 Tranthoracic echocardiography (A) and transesophageal echocardiography (B) showed a 6.5 cm mobile mass in the right atrium and a 3.5 cm mobile mass in the left atrium (arrows). Coronary angiography revealed no stenotic lesions, but we observed feeding vessels (arrows) from the left circumflex artery and the proximal right coronary artery to the primary cardiac lymphoma (C and D).

• 

  Fig. 2 Cardiac CT (A and B) showed huge bi-atrial masses with invasion into the atrial septum, pericardium and myocardium. Positron emission tomography-CT showed a markedly increased fluorodeoxyglucose uptake in the heart and pericardium and in the mediastinal and right supracalvicular lymph nodes (C). After six rounds of chemotherapy, masses of primary cardiac lymphoma were remarkablely decreased (D, E and F). An Abscess of the right lower pulmonary lobe occurred during chemotherapy (D).

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  Fig. 3 Hematoxylin-Eosin staining (high power field, ×400) (A) was consistent with a diffuse large B cell lymphoma. This was confirmed by immunohistology. The cells were CD20 B positive (B) and CD3 T negative.

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  Fig. 4 Follow-up tranthoracic echocardiography (A) and transesophageal echocardiography (B) revealed <1 cm sized remnant masses (arrows) in the both atria.

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