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Published on: March 30, 2018
CD5+ diffuse large B-cell lymphoma with c-myc/IgH rearrangement presenting as primary effusion lymphoma
Shinya Fujisawa1, Fumihiko Tanioka, Toshihiko Matsuoka
1Department of Infectious Disease, Hamamatsu Medical Center, Hamamatsu 432-8580, Japan. shinfuji@hmedc.or.jp
Insights
This case highlights diffuse large B-cell lymphoma (DLBCL) presenting as acute heart failure. CD5+ lymphoma with c-myc/IgH rearrangement can manifest as pericardial effusion.
Area of Science:
- Oncology
- Hematology
- Cardiology
Background:
- Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin lymphoma.
- Cardiac involvement in lymphoma is uncommon but can be life-threatening.
- This case explores an unusual presentation of DLBCL.
Observation:
- A 69-year-old man presented with fatigue and was found to have pericardial effusion.
- Computed tomography revealed effusion but no overt tumor masses or lymphadenopathy.
- During chemotherapy, lactate dehydrogenase and pleural effusion increased.
Findings:
- Tumor cells were CD5+, CD19+, CD20+, kappa chain+, Bcl-2+, and CD10-, CD23-.
- Cytogenetic analysis showed t(8;14)(q24;q32) with c-myc/immunoglobulin (Ig)H rearrangement.
- The MIB-1 index was 60%, and viral DNA (HHV-8, EBV) was not detected.
Implications:
- CD5+ lymphoma can present with pericardial effusion and acute heart failure.
- The presence of c-myc/IgH rearrangement in CD5+ lymphoma indicates a poor prognosis.
- This case expands the spectrum of clinical manifestations for CD5+ DLBCL.
Abstract:
We report an instructive case of diffuse large B-cell lymphoma presenting as acute heart failure. A 69-year-old human immunodeficiency virus-negative man was admitted to our hospital for general fatigue. A computed tomographic scan of the chest and abdomen showed pericardial effusion, but there was no evidence of tumor masses, lymph node enlargement, or hepatosplenomegaly. During the chemotherapy, increased lactate dehydrogenase and pleural effusion appeared. The tumor cells in the effusion showed positivity for CD5, CD19, CD20, kappa chain, and Bcl-2 and negativity for CD10 and CD23. The chromosomes showed t(8;14)(q24;q32) with c-myc/immunoglobulin (Ig)H rearrangement, and the MIB-1 index was not high (60%). Neither human herpes virus 8 nor Epstein-Barr virus DNA was detected in the cells by polymerase chain reaction. The response to chemotherapy was very poor, and the patient died 4 months after the diagnosis. A spectrum of the symptoms of CD5+ lymphoma encompasses pericardial effusion and also can accompany c-myc/IgH rearrangement.
