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[Malignant non-Hodgkin's lymphoma presenting with arrhythmia and conduction defects. Report of 2 cases]
1Service de pathologie cardiovasculaire, hôpital d'instruction des armées du Val-de-Grâce, 74, bd de Port-Royal, 75230 Paris.
Insights
Primary cardiac lymphoma is rare, often diagnosed post-mortem. Early chemotherapy is crucial for cardiac lymphoma, even when presenting as arrhythmias or conduction defects.
Area of Science:
- Cardiology
- Oncology
- Pathology
Background:
- Primary cardiac lymphoma is exceptionally rare, with secondary cardiac involvement occurring in 15-30% of autopsy cases.
- Clinical manifestations of cardiac lymphoma are infrequent, leading to a high rate of post-mortem diagnosis.
- Arrhythmias and conduction defects are uncommon presentations of cardiac involvement.
Observation:
- Two cases of cardiac lymphoma are presented: a 35-year-old man with primary cardiac lymphoma presenting as ventricular tachycardia and atrioventricular block, and a 37-year-old man with secondary cardiac lymphoma from cutaneous T-cell lymphoma, where atrioventricular block was the initial sign.
- The first case demonstrated ventricular tachycardia progressing to complete atrioventricular block (AVB) with pseudo-inferior wall infarction.
- The second case highlighted complete AVB as the first indicator of secondary cardiac lymphoma.
Findings:
- Cardiac lymphoma can manifest with significant arrhythmias and conduction abnormalities.
- Atrioventricular block (AVB) can be a presenting symptom of both primary and secondary cardiac lymphoma.
- Pseudo-inferior wall infarction may be associated with cardiac lymphoma presentation.
Implications:
- Prompt diagnosis and aggressive chemotherapy are vital for managing cardiac lymphoma.
- Increased clinical suspicion for cardiac lymphoma is warranted in patients presenting with unexplained arrhythmias or conduction defects.
- Early detection and treatment of cardiac lymphoma can improve patient outcomes.
Abstract:
Primary cardiac lymphoma is very rare. Secondary localisations are more common, observed in 15 to 30% of autopsy series. Clinical symptoms of cardiac involvement are rare, explaining the usual post-mortem diagnosis. The presentation of cardiac involvement by arrhythmias and conduction defects is very uncommon. The authors report two cases, the first of a 35 year old man in whom primary cardiac lymphoma presented with ventricular tachycardia complicated secondarily by complete atrioventricular block (AVB) with pseudo-inferior wall infarction. The second case was a 37 year old man with a cutaneous T cell lymphoma in whom complete AVB was the first sign of a secondary cardiac localisation of his disease. The finding of cardiac lymphoma should lead to aggressive chemotherapy as soon as possible.