Case Report: Cardiac Involvement by Lymphoma: Rare but Heterogeneous Condition With Challenging Behaviors

Lucchini, Elisa; Merlo, Marco; Ballerini, Mario; Porcari, Aldostefano; Sinagra, Gianfranco; Pagnan, Lorenzo; Rensi, Marco; Romano, Andrea; Bussani, Rossana; Ballotta, Laura; Zaja, Francesco

doi:10.3389/fonc.2021.665736

Cited by 9 publications

(5 citation statements)

References 25 publications

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“…The most prevalent form of secondary cardiac involvement occurs in patients with DLBCL. In most cases of secondary cardiac lymphoma, symptoms are attributed to heart failure or rhythm alterations [14], which is similar to our case. While there are no established guidelines for the management of cardiac lymphoma, treatment approaches for cardiac lymphoma involve chemotherapy, often combined with radiotherapy, surgery, autologous hematopoietic stem cell transplantation, and chimeric antigen receptor (CAR) T-cell therapy [15,16].…”

Section: Discussionsupporting

confidence: 88%

Chromosomal Translocations t(1; 22)(q21; q11.2) and t(6; 18)(p25; q21) in a Patient with Diffuse Large B-cell Lymphoma: FISH Analysis

Kitamura,

Kubota,

Hanamura

et al. 2023

Preprint

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Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma and a heterogeneous disease characterized by mature B-cell neoplasms. The standard immunochemotherapy for DLBCL is R-CHOP, which includes rituximab, cyclophosphamide, doxoru-bicin, vincristine, and prednisone. Up to 30-40% of patients with DLBCL either exhibit primary refractory disease to standard treatment or experience relapse after the initial response. A 72-year-old man diagnosed with DLBCL involving chromosomal translocations t(1;22)(q21;q11.2) and t(6;18)(p25;q21) showed primary refractory disease after the fourth cycle of R-CHOP. The patient ultimately experienced cardiac involvement by the lymphoma and received salvage chemotherapy. He passed away about 15 months away after the diagnosis of DLBCL. We conducted fluorescence in situ hybridization (FISH) for further analysis of the chromosomal translocations. The breakpoint of chromosome 1q21 was located at a distance of around 151 Mb from the telomeric end of chromosome 1p. The breakpoint in chromosome 22q11 contains the immunoglobulin lambda locus. Furthermore, the breakpoint of chromosome 6p was in the telomeric region of chromosome 6p21. The breakpoint of chromosome 18q21 contains BCL2. This case report presents the first documented co-occurrence of chromosomal translocations t(1;22)(q21;q11.2) and t(6;18)(p25;q21) in a patient with DLBCL. These chromosomal translocations may indicate a worse clinical outcome.

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Section: Discussionsupporting

confidence: 88%

Chromosomal Translocations t(1; 22)(q21; q11.2) and t(6; 18)(p25; q21) in a Patient with Diffuse Large B-cell Lymphoma: FISH Analysis

Kitamura,

Kubota,

Hanamura

et al. 2023

Preprint

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“…The absence of myocardial uptake (i.e., Perugini grade 0) does not always exclude the diagnosis. In patients with suspected CA based on characteristic non-invasive cardiac imaging, the absence of myocardial uptake is still consistent with the low sensitivity of cardiac scintigraphy in presence of rare TTR mutations (i.e., Phe64Leu, Val30Met, Ser77Tyr) [32], non-ATTR forms of amyloidosis [33,34], or AL amyloidosis. Specifically, there are others several scenarios in which a negative result can be observed on cardiac scintigraphy: in very early stages of cardiac amyloidosis, its accumulation may be difficult to detect even with bone tracers; in the presence of a large area of necrosis resulting from a previous infarction, bone tracer accumulation may not occur; if images are acquired too late or too early in the course of radiotracer administration, a false negative may be obtained.…”

Section: Clinical Application Of Cardiac Scintigraphy With Bone Tracerssupporting

confidence: 58%

Lights and Shadows of Clinical Applications of Cardiac Scintigraphy with Bone Tracers in Suspected Amyloidosis

Saro,

Pavan,

Porcari

et al. 2023

JCM

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Radionuclide bone scintigraphy is the cornerstone of an imaging-based algorithm for accurate non-invasive diagnosis of transthyretin cardiac amyloidosis (ATTR-CA). In patients with heart failure and suggestive echocardiographic and/or cardiac magnetic resonance imaging findings, the positive predictive value of Perugini grade 2 or 3 myocardial uptake on a radionuclide bone scan approaches 100% for the diagnosis of ATTR-CA as long as there is no biochemical evidence of a clonal dyscrasia. The technetium-labelled tracers that are currently validated for non-invasive diagnosis of ATTR-CA include pyrophosphate (99mTc-PYP); hydroxymethylene diphosphonate (99mTc-HMDP); and 3,3-diphosphono-1,2-propanodicarboxylate (99mTc-DPD). Although nuclear scintigraphy has transformed the contemporary diagnostic approach to ATTR-CA, a number of grey areas remains, including the mechanism for binding tracers to the infiltrated heart, differences in the kinetics and distribution of these radiotracers, differences in protocols of image acquisition worldwide, the clinical significance of extra-cardiac uptake, and the use of this technique for prognostic stratification, monitoring disease progression and assessing the response to disease-modifying treatments. This review will deal with the most relevant unmet needs and clinical questions concerning scintigraphy with bone tracers in ATTR-CA, providing expert opinions on possible future developments in the clinical application of these radiotracers in order to offer practical information for the interpretation of nuclear images by physicians involved in the care of patients with this ATTR-CA.

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“…However, shortness of breath is often seen if a large mass occurs in the left atrial or left ventricular region ( 10 ). The most common clinical symptom described is dyspnea (64%), followed by constitutional problems (26%) and chest pain (24%) ( 11 , 54 ). In our review ( Table 1 ), the results are the same.…”

Section: Discussionmentioning

confidence: 99%

“…The optimum imaging technique to determine whether the malignancy has affected the heart is CMRI ( 1 , 51 ). Cardiovascular tumors show hypointense in T1-weighted sequences, while appearing hyperintense in T2-weighted sequences ( 11 , 51 ). If there is a possibility of cardiac involvement, magnetic resonance imaging should be chosen despite the fact that these various imaging modalities should be considered complementary rather than competitive ( 53 , 54 ).…”

Section: Discussionmentioning

confidence: 99%

Relapsed/refractory diffuse large B cell lymphoma with cardiac involvement: A case report and literature review

Yang

et al. 2023

Front. Oncol.

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BackgroundHematological malignancies of the heart (CHMs) are extremely rare, and include leukemia, lymphoma infiltration, and multiple myeloma with extramedullary manifestations. Cardiac lymphoma can be divided into primary cardiac lymphoma (PCL) and secondary cardiac lymphoma (SCL). Compared to PCL, SCL is relatively more common. Histologically, the most frequent SCL is diffuse large B-cell lymphoma (DLBCL). The prognosis of lymphoma in patients with cardiac involvement is extremely poor. CAR T-cell immunotherapy has been recently become a highly effective treatment for relapsed or refractory diffuse large B-cell lymphoma. To date, there are no guidelines that provide a clear consensus on the management of patients with secondary heart or pericardial involvement. We report a case of relapsed/refractory DLBCL that secondarily affected the heart.Case presentationA male patient was diagnosed with double-expressor DLBCL based on biopsies of mediastinal and peripancreatic masses and fluorescence in situ hybridization. The patient received first-line chemotherapy and anti-CD19 CAR T cell immunotherapy, but developed heart metastases after 12 months. Considering his physical condition and economic situation of the patient, two cycles of multiline chemotherapies were administered, followed by CAR-NK cell immunotherapy and allogeneic hematopoietic stem cell transplantation (allo-HSCT) at another hospital. After achieving a six-month survival, the patient died of severe pneumonia.ConclusionThe response of our patient emphasizes the importance of early diagnosis and timely treatment to improve the prognosis of SCL and serves as an important reference for SCL treatment strategies.

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Case Report: Cardiac Involvement by Lymphoma: Rare but Heterogeneous Condition With Challenging Behaviors

Cited by 9 publications

References 25 publications

Chromosomal Translocations t(1; 22)(q21; q11.2) and t(6; 18)(p25; q21) in a Patient with Diffuse Large B-cell Lymphoma: FISH Analysis

Chromosomal Translocations t(1; 22)(q21; q11.2) and t(6; 18)(p25; q21) in a Patient with Diffuse Large B-cell Lymphoma: FISH Analysis

Lights and Shadows of Clinical Applications of Cardiac Scintigraphy with Bone Tracers in Suspected Amyloidosis

Relapsed/refractory diffuse large B cell lymphoma with cardiac involvement: A case report and literature review

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