Cardiac lymphoma

Case contributed by Dr Nolan Walker

Presentation

Shortness of breath. Otherwise fit and well. Previous history of B-cell lymphoma treated 15 years ago.

Patient Data

Age: 75 years
Gender: Male
X-ray

PA chest X-ray

There are bilateral pleural effusions with associated atelectatic changes at the lung bases. 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 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
Published: 29th Jul 2015
Last edited: 25th Jul 2018
Inclusion in quiz mode: Included

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