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Primary cardiac lymphoma initially diagnosed by routine cytology. Case report and literature review
M J Castelli1, M L Mihalov, H V Posniak
1Department of Pathology, Loyola University Medical Center, Maywood, IL 60153.
Insights
Primary cardiac lymphoma, a rare condition, was diagnosed using routine cytologic examination of pericardial fluid. This diagnostic approach proved effective in identifying malignant lymphoma in a patient presenting with chest pain.
Area of Science:
- Cardiology
- Oncology
- Pathology
Background:
- Primary cardiac lymphoma is a rare malignancy.
- Initial presentation can mimic common cardiac conditions like ischemic heart disease.
Observation:
- A 64-year-old woman presented with chest pain and heart block.
- Echocardiogram revealed pericardial effusion; fluid analysis was performed.
- Coronary angiography did not show significant coronary artery disease.
Findings:
- Cytologic examination of pericardial fluid diagnosed large cell malignant lymphoma.
- Intracardiac mass involving the atrioventricular canal was identified.
- Surgical biopsy confirmed the diagnosis of large cell lymphoma.
Implications:
- Routine cytologic examination of effusion fluid is a valuable diagnostic tool for rare cardiac tumors.
- Early diagnosis of primary cardiac lymphoma can be achieved through non-invasive fluid analysis.
- Highlights the importance of considering lymphoma in cardiac effusions when initial diagnoses are inconclusive.
Abstract:
A case of primary cardiac lymphoma initially diagnosed by routine cytologic examination of pericardial fluid is presented. In a 64-year-old woman woman who originally presented with chest pain and heart block, the initial clinical impression was ischemic heart disease. However, coronary angiography failed to reveal significant disease. An echocardiogram demonstrated pericardial fluid, which was drained. A small amount was sent for cytologic examination, and the diagnosis of malignant lymphoma, large cell type, was made. Subsequent radiologic examinations revealed an intracardiac mass involving the atrioventricular canal; surgical biopsy confirmed the diagnosis of a large cell lymphoma. While primary malignant lymphoma of the heart is rare, this case highlights the efficacy of routine cytologic examination of an effusion fluid (often drained therapeutically) in establishing the correct diagnosis.