Primary cardiac lymphoma: a case report

Area of Science:

• Cardiology
• Oncology
• Medical Imaging

Background:

• Primary cardiac lymphoma is an exceptionally rare malignancy affecting the heart and pericardium.
• It most frequently involves the right atrium and right ventricle, carrying a poor prognosis if untreated.
• Recent therapeutic advances, including early detection and chemotherapy, have improved survival rates.

Observation:

• A 78-year-old female presented with symptoms including weight loss, abdominal pain, and distension, with initial findings of abdominal ascites.
• Echocardiography revealed a large pericardial effusion, asymmetrical left ventricular wall thickening, and a left atrial mass.
• Pericardial fluid analysis confirmed diffuse large B-cell non-Hodgkin's lymphoma, with PET-CT showing significant fluorodeoxyglucose uptake in the cardiac muscle.

Findings:

• The patient received prompt treatment with a chemotherapy regimen (Rituximab, Cyclophosphamide, doxorubicin, vincristine, and prednisolone - R-CHOP).
• Post-treatment echocardiography demonstrated resolution of the pericardial effusion and left atrial mass, with improved left ventricular wall thickness.
• A follow-up PET-CT scan confirmed a complete metabolic response to the R-CHOP chemotherapy.

Implications:

• Primary cardiac lymphoma, especially with left heart involvement, is uncommon, underscoring the importance of multimodality imaging for diagnosis.
• Early diagnosis and timely treatment initiation are vital for improving survival and reducing morbidity and mortality associated with this rare cancer.
• This case highlights the efficacy of R-CHOP chemotherapy in achieving complete remission for primary cardiac lymphoma, offering hope for improved patient prognoses.