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Published on: March 30, 2018
Cardiac involvement by malignant lymphoma: a clinicopathologic study of 25 autopsy cases based on the WHO
Katsuya Chinen1, Toshiyuki Izumo
1Department of Pathology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan. kchinen@kyorin-u.ac.jp
Insights
Cardiac lymphoma (CL) is rare and difficult to diagnose before death. T-cell lymphomas, unlike B-cell lymphomas, more frequently invade the heart, causing serious cardiac issues and sudden death.
Area of Science:
- Oncology
- Pathology
- Cardiology
Background:
- Cardiac involvement by malignant lymphoma (ML) is uncommon.
- Antemortem diagnosis of cardiac lymphoma (CL) is challenging.
- Clinicopathologic features of CL require further elucidation.
Purpose of the Study:
- To clarify the clinicopathologic features of cardiac lymphoma (CL).
- To investigate the relationship between tumor phenotype and cardiac manifestation.
- To identify risk factors and clinical outcomes associated with CL.
Main Methods:
- Retrospective analysis of 25 autopsy cases of cardiac lymphoma.
- Rediagnosis based on World Health Organization (WHO) classification.
- Investigation of clinicopathologic characteristics by tumor phenotype (B-cell vs. T-cell).
Main Results:
- All cases were secondary CL, undiagnosed antemortem.
- 14 cases (56%) were B-cell, 11 (44%) were T-cell phenotype.
- T-cell lymphomas, especially nasal NKTLs, showed higher incidence and more aggressive cardiac invasion, leading to arrhythmia and sudden death.
Conclusions:
- T-cell lymphomas exhibit more frequent and aggressive cardiac invasion than B-cell lymphomas.
- CL, particularly T-cell types, is associated with significant cardiac manifestations like tamponade, heart failure, arrhythmia, and sudden death.
- Aggressive diagnostic approaches are crucial for suspected CL, especially in T-cell ML and nasal NKTL cases.
Abstract:
As cardiac involvement by malignant lymphoma (ML) is relatively uncommon and antemortem diagnosis is difficult, details of this condition remain to be elucidated. To clarify clinicopathologic features of cardiac lymphoma (CL), 25 autopsy cases were studied. Each was rediagnosed according to the World Health Organization (WHO) classification, and clinicopathologic characteristics were investigated by tumor phenotype. The study subjects were 13 males and 12 females with a mean age of 53.4 years. All cases were secondary CL and were not diagnosed as CL before death; 14 cases (56%) were of B-cell and 11 (44%) of T-cell (including natural killer cell) phenotype. Nasal and nasal-type natural killer/T-cell lymphomas (NKTLs) accounted for five (20%). Cardiac manifestation was evident in eight (32%), with hematogenous infiltration as the most common pattern of tumor spread. Some B-cell CLs (n=3) were complicated by cardiac tamponade and heart failure (HF), and T-cell CLs (n=5), including three nasal NKTLs, also featured arrhythmia and sudden death. The incidence of T-cell phenotype was significantly elevated for CLs (p<0.05), especially for CLs with cardiac manifestation (p<0.01), compared with that for MLs in general. Our results indicate that T-cell lymphomas, compared with B-cell lymphomas, invade the heart more frequently and aggressively and are associated with a variety of cardiac manifestations. Where cardiac involvement is suspected, aggressive diagnostic procedures are warranted, especially with MLs having a T-cell phenotype. In cases of nasal NKTL, particular attention is necessary.
