Acute heart failure due to fulminant myocardial infiltration by a diffuse large B-cell lymphoma

Area of Science:

• Oncology
• Cardiology
• Pathology

Background:

• Secondary cardiac lymphoma is a frequent metastatic malignancy of the heart, often secondary to lung and breast carcinomas.
• Non-Hodgkin lymphomas constitute the majority of primary and secondary cardiac lymphomas.
• The pericardium is the most commonly affected cardiac structure, though myocardium and endocardium can also be involved.

Observation:

• A patient presented with dyspnea due to cardiac tamponade, diagnosed with secondary cardiac diffuse large B-cell lymphoma.
• The lymphoma infiltrated the heart extensively, leading to rapid progression.
• Histological diagnosis was not obtained before death due to the rapid progression of the disease.

Findings:

• The patient died one month post-pericardial fenestration from acute left and right heart failure.
• Autopsy confirmed massive lymphomatous infiltration of the heart, thyroid, abdominal lymph nodes, left kidney, pancreas, and right testis.
• Diffuse lymphomatous infiltration was the cause of death.

Implications:

• This case underscores the aggressive nature and rapid progression of secondary cardiac lymphoma.
• Early recognition and diagnosis are crucial for managing cardiac tamponade and heart failure in these patients.
• Further research into the mechanisms of rapid cardiac infiltration in lymphoma is warranted.