Korean Circ J.  2010 Feb;40(2):94-98. 10.4070/kcj.2010.40.2.94.

Primary Cardiac Lymphoma Presenting With Atrioventricular Block

• Cho SW
• Kang YJ
• Kim TH
• Cho SK
• Hwang MW
• Chang W
• Rhee KJ
• Kim BO
• Goh CW
• Park KM
• Kim JH
• Byun YS
• Yuh YJ

• KMID: 2297946
• DOI: http://doi.org/10.4070/kcj.2010.40.2.94

Abstract

Primary cardiac lymphomas (PCL) are extremely rare. Clinical manifestations may be variable and are attributed to location. Here, we report on a case of PCL presenting with atrioventricular (AV) block. A 55 year-old male had experienced chest discomfort with unexplained dyspnea and night sweating. His initial electrocardiogram (ECG) revealed a first degree AV block. Along with worsening chest discomfort and dyspnea, his ECG changed to show second degree AV block (Mobitz type I). Computed tomography (CT) scan showed a cardiac mass (about 7 cm) and biopsy was performed. Pathologic finding confirmed diffuse large B-cell lymphoma. The patient was treated with multi-drug combination chemotherapy (R-CHOP: Rituximab, cyclophoshamide, anthracycline, vincristine, and prednisone). After treatment, ECG changed to show normal sinus rhythm with complete remission on follow-up CT scan.

Keyword

Lymphoma, Large B-cell, Diffuse; Cardiac tumor; Atrioventricular block

MeSH Terms

Antibodies, Monoclonal, Murine-Derived
Atrioventricular Block
Biopsy
Drug Therapy, Combination
Dyspnea
Electrocardiography
Follow-Up Studies
Heart Neoplasms
Humans
Lymphoma
Lymphoma, B-Cell
Lymphoma, Large B-Cell, Diffuse
Male
Sweat
Sweating
Thorax
Vincristine
Rituximab
Antibodies, Monoclonal, Murine-Derived
Vincristine

Figure

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  Fig. 1 ECG showing first degree AV block. AV: atrioventricular, ECG: electrocardiogram.

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  Fig. 2 Thoracic aorta CT demonstrating a multi-lobulating, low density mass (about 7 cm) with an irregular shape in the right atrium, extending to the periaortic space of the ascending aorta and left atrium (arrows). A: coronal view. B: sagittal view. LV: left ventricle, LA: left atrium, RV: right ventricle.

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  Fig. 3 ECG showing second degree AV block. A: Mobitz type I. B: 2 : 1 AV block. AV: atrioventricular, ECG: electrocardiogram.

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  Fig. 4 Histologic findings. A: in H&E staining, large lymphocytes with high mitotic activity showed diffuse infiltration. In immunochemical staining. B: CD 20, the B cell marker, showed a positive result. C: CD 3, the T cell marker, showed a negative result.

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  Fig. 5 ECG showing normal PR interval after 3 cycles of chemotherapy. ECG: electrocardiogram.

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  Fig. 6 Thoracic aorta CT revealing disappearance of the cardiac mass after 3 cycles of chemotherapy. A: coronal view. B: sagittal view. LV: left ventricle, LA: left atrium, RV: right ventricle, RA: right atrium.

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  Fig. 7 Positron emission tomography CT revealing complete remission state after 6 cycles of chemotherapy.

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