Cardiac lymphoma

Case contributed by Dr Nolan Walker

Presentation

Patient presented with shortness of breath. Otherwise fit and well. Previous history of B-cell lymphoma treated 15 years ago.

Patient Data

Age: 76
Gender: Male
X-ray

PA chest X-ray

Small right sided pleural effusion with associated right basal atelectasis.

Otherwise normal.

CT

CTPA

CTPA for investigation of possible pulmonary embolus.

This revealed a homogenous mediastinal mass.

The component of the mass within the superior mediastinum encased the right coronry artery.

The mass extended into the middle mediastinum where it invaded the right ventricular wall.

CT

CT guided biopsy

CT guided biopsy with 16G coaxial Temno biopsy needle.

Nuclear medicine

PET-CT findings:

There  is  high  grade  increased  tracer  uptake  associated  with the  large  cardiac  mass  occupying  the  right  atrium,  right ventricle  and  extending  into  anterior  mediastinal  soft tissue.  The  spleen  is  not  enlarged  and  bone  marrow  uptake  is normal.

Interpretation: 

Appearances  are  in  keeping  with metabolically  active  disease  within  cardiac  mass  extending into  the  anterior  mediastinum,  most  likely  lymphoma.  There is  no  evidence  of  metabolically  active  disease  elsewhere.

Case Discussion

The CT findings of the mediastinal mass were initially thought to represent either a cardiac angiosarcoma or possibly a secondary cardiac lymphoma in view of the patient's previous history.

Pathology report

Core biopsy showing a diffuse large B-cell lymphoma.

Immunohistochemistry shows expression of CD20, CD79a, Bcl6, MUM-1, Bcl2 and not CD10, CD5, CD23, CD30, EBER, CD3.

Case presented with Dr. Panos Gkoutzios,

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Case information

rID: 38690
Case created: 29th Jul 2015
Last edited: 15th Sep 2017
Inclusion in quiz mode: Included

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