A Case of Primary Cardiac B Cell Lymphoma Associated With Ventricular Tachycardia, Successfully Treated With Systemic Chemotherapy and Radiotherapy

Miyashita, Tetsuya; Mataga, Izumi; Kawaguchi, Tetsu; Kasai, Toshio; Yamaura, Takahiro; Ito, Toshiro; Takei, Manabu; Kiyosawa, Kendo

doi:10.1253/jcj.64.135

Cited by 37 publications

(39 citation statements)

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“…Association of VT with malignant lymphoma was previously reported in 3 cases with primary cardiac lymphoma involving the myocardium and a case with secondary cardiac lymphoma involving the right ventricular cavity (7)(8)(9)(10). However, to our best knowledge, this is the first report of secondary myocardial lymphoma presenting with ventricular tachycardia in the English literature.…”

Section: Discussionmentioning

confidence: 92%

A Case of Secondary Myocardial Lymphoma Presenting with Ventricular Tachycardia

et al. 2002

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Malignant lymphoma can involve the cardiac cavity or myocardium as a mass. Clinical symptoms of its cardiac involvement are usually absent or nonspecific, making the diagnosis of the cardiac involvement very difficult before death. We experienced a patient with secondary myocardial non-Hodgkin's lymphoma presenting with sustained ventricular tachycardia (VT) as a primary clinical problem. A 39-yr-old woman visited our hospital because of dyspnea and palpitation for 7 days. Physical examination revealed rapid heart beat with variable intensity of the first heart sound and soft mass in the lower abdomen. VT with a cycle length of 480 msec was recorded in resting 12-lead electrocardiogram. Two well-circumscribed hypo-echogenic round masses were demonstrated in the interventricular septum and left ventricular posterior wall. Cytological examination of aspirated pericardial fluid and percutaneous needle biopsy of the abdominal mass revealed a diffuse large cell type non-Hodgkin's lymphoma. Myocardial masses and ventricular tachycardia resolved with chemotherapy using cyclophosphamide, adriamycin, vincristine and prednisone regimen. To our best knowledge, the same case as ours has not been reported previously.

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Section: Discussionmentioning

confidence: 92%

A Case of Secondary Myocardial Lymphoma Presenting with Ventricular Tachycardia

et al. 2002

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“…2 Radiation after chemotherapy improved survival in a few cases. 2,3 We avoided the use of anthracyclin during the first 2 cycles of the chemotherapy in the present patient because we feared that cardiac toxicity could be fatal. The early phase of chemotherapy is critical, as suggested by reports of sudden death from pulmonary embolism 2 and ventricular tachycardia.…”

Section: Discussionmentioning

confidence: 98%

“…2 The right atrium is involved in most patients and infiltration of the conductive system can produce many types of arrhythmias, such as atrial fibrillation, atrioventricular block, sick sinus syndrome, ventricular tachycardia, and ventricular fibrillation. 2,3,[10][11][12][13] Unusual clinical findings are related to multiple pulmonary embolism, and symptoms mimicking hypertrophic cardiomyopathy. 14,15 The present case had severe diastolic dysfunction and several different arrhythmias on the first admission and the presumptive diagnosis was restrictive cardiomyopathy because cardiac catheterization showed a typical 'dip-andplateau' waveform and CT did not reveal pericardial constriction or thickening.…”

Section: Discussionmentioning

confidence: 99%

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Primary Cardiac Lymphoma Presenting Clinically as Restrictive Cardiomyopathy

Fujisaki

Tanaka

Kato

et al. 2005

Circ J

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rimary cardiac lymphoma (PCL) is extremely rare, accounting for only 1.3% of all primary cardiac tumors, 1 and its prognosis is poor because its rarity and nonspecific clinical presentation make an antemortem diagnosis difficult. 2 However recent reports suggest that early diagnosis and proper treatment can lead to long-term survival. 2,3 We report an unusual case of PCL in which the patient presented a clinical picture of restrictive cardiomyopathy with arrhythmias that resolved following systemic chemotherapy. Diastolic heart failure caused by PCL has rarely been described. 4 Case ReportA 72-year-old woman was admitted for evaluation of exertional dyspnea and palpitations. She had been well until the year before admission, during which exertional dyspnea gradually worsened. Five months prior to admission, a dry cough developed and 1 month prior, the exertional dyspnea and palpitations rapidly worsened, and she reported a 6 kg weight gain in that month.On admission, the patient's blood pressure was 124/ 61 mmHg and her heart rate was 40 beats/min. Jugular venous distension was marked. The first and second heart sounds were normal, and no murmurs were detected. Inspiratory rales were present at the base of both lungs. The liver was palpable 2 cm below the right costal margin. There was peripheral edema. No lymphadenopathy was noted. Circulation Journal Vol.69, February 2005Laboratory investigations were normal except for a slight elevation in the serum lactate dehydrogenase (LDH) concentration (566 IU/L). Chest roentgenogram showed cardiomegaly, pulmonary congestion, and distended pulmonary arteries (Fig 1). Electrocardiography (ECG) revealed atrioventricular dissociation with a ventricular rate of 40 beats/min (Fig 2). Transthoracic echocardiography showed mild atrial and ventricular enlargement. There were not any findings of pericardial effusion, pericardial thickness, or cardiac tumor. The ejection fraction of the left ventricle was 67%. Doppler echocardiography revealed tricuspid regurgitation with a pressure gradient of 34 mmHg. Cardiac catheterization revealed an increased right enddiastolic pressure of 17 mmHg and a left end-diastolic pres- An unusual case of primary cardiac lymphoma presenting as restrictive cardiomyopathy with arrhythmia is reported in a 72-year-old woman who was admitted for evaluation of exertional dyspnea and palpitations. Electrocardiography (ECG) showed atrioventricular dissociation and right heart cardiac catheterization revealed a typical 'dip-and-plateau' waveform. Restrictive cardiomyopathy was suspected because computed tomography (CT) did not reveal pericardial thickening, calcifications, or an effusion. Heart failure initially improved with diuretic therapy, but subsequently worsened, and the patient experienced a syncopal episode. ECG showed atrial fibrillation, and CT revealed a large mass in the right atrium and multiple tumors in the liver, which needle biopsy confirmed as diffuse large B-cell lymphoma. Chemotherapy induced complete remission, and her heart failure mark...

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“…Patients may present with signs of heart failure, cardiac tamponade, or arrhythmias, depending on the site of the tumor, and tumors are rarely detected before death. 1 Almost all patients die within weeks. We report a case of primary cardiac B-cell nonHodgkin's lymphoma in which lymphoma cells expressed a CD20 molecule and the patient was treated successfully with monoclonal CD20 antibody (rituximab).…”

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confidence: 99%