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Secondary Giant Cardiac Lymphoma Treated by Stepwise Chemotherapy With Multimodal Imaging
Shota Inoue1, Koki Nakanishi2, Yuriko Yoshida3
1Department of Clinical Laboratory Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Background:
Metastatic cardiac lymphoma is rare and may present as a large mass with a high risk of hemodynamic compromise and poor outcomes.
Case Summary:
A 79-year-old woman who had a history of thyroid mucosa-associated lymphoid tissue (MALT) lymphoma and achieved remission after radiotherapy presented with dyspnea and edema. Transthoracic echocardiography and computed tomography revealed a large mass occupying the right atrium and ventricle. Biopsy confirmed diffuse large B-cell lymphoma, suggesting a late transformation of MALT lymphoma with cardiac involvement. Low-dose chemotherapy was initiated and gradually escalated with multimodal imaging guidance, resulting in marked mass regression without complications.
Discussion:
Transformation of MALT lymphoma into diffuse large B-cell lymphoma can occur after long-term remission and present as isolated cardiac involvement. Stepwise chemotherapy may help reduce the risk of embolic events and cardiac rupture.
Take-Home Message:
Serial multimodal imaging plays a pivotal role in monitoring the response to chemotherapy in patients with cardiac lymphoma.