Complete regression of myocardial involvement associated with lymphoma following chemotherapy

Abstract

Cardiac involvement as an initial presentation of malignant lymphoma is a rare occurrence. We describe the case of a 26 year old man who had initially been diagnosed with myocardial infiltration on an echocardiogram, presenting with a testicular mass and unilateral peripheral facial paralysis. On admission, electrocardiograms (ECG) revealed negative T-waves in all leads and ST-segment elevation in the inferior leads. On two-dimensional echocardiography, there was infiltration of the pericardium with mild effusion, infiltrative thickening of the aortic walls, both atria and the interatrial septum and a mildly depressed systolic function of both ventricles. An axillary biopsy was performed and reported as a T-cell lymphoblastic lymphoma (T-LBL). Following the diagnosis and staging, chemotherapy was started. Twenty-two days after finishing the first cycle of chemotherapy, the ECG showed regression of T-wave changes in all leads and normalization of the ST-segment elevation in the inferior leads. A follow-up Two-dimensional echocardiography confirmed regression of the myocardial infiltration. This case report illustrates a lymphoma presenting with testicular mass, unilateral peripheral facial paralysis and myocardial involvement, and demonstrates that regression of infiltration can be achieved by intensive chemotherapy treatment. To our knowledge, there are no reported cases of T-LBL presenting as a testicular mass and unilateral peripheral facial paralysis, with complete regression of myocardial involvement.

Metastatic Cardiac Tumor from Precursor B Cell Lymphoblastic Lymphoma with a Mediastinal Mass: A Case Report of a 12-Years-Old African Girl

“…Most diagnoses are made on postmortem. The non specific presentation made the diagnosis of the tumor difficult and delayed which is similar to what is encountered in other cases of cardiac infiltration by malignant lymphomas [5].…”

“…Cardiac involvement due to lymphomas is not widely investigated. Symptoms are usually non specific to the primary tumor, difficult to diagnose almost always associated with advanced disease and are fatal [4,5]. A lot of emphasis has been put on cardiomyopathy related to chemotherapy.…”

Cardiac lymphoma with early response to chemotherapy: A case report and review of the literature

“…In particular, T-cell lymphomas seem to be more related to sudden cardiac death when compared to B-cell ones, because of a highest predisposition to infiltration. 5 …”

Cardiac Infiltration as the First Manifestation of Acute Lymphoblastic Leukemia: A Systematic Review

“…In the included 30 cases, 80% (24/30) of patients presented cardiac manifestations before ALL was diagnosed. In total, 33.3% (8/24) of cases (7)(8)(9)(10)(11)(12)(13)(14) had detected a persistent pericardial effusion and/or cardiac tamponade, 33.3% (8/24) of cases (15)(16)(17)(18)(19)(20)(21)(22) had detected a cardiac mass, and 33.3% (8/24) of cases (23)(24)(25)(26)(27)(28)(29)(30) had detected severe cardiac hypertrophy by TTE (7-18, 20-22, 24-30) and/or CMR (19,23) test. All of these 24 cases were diagnosed with ALL by further tests of BMB (7,(16)(17)(18)(19), BMA (8)(9)(10)(11)14), EMB (25,27,29,30), cytologic analysis (12,13,15,24), or tissue biopsy (20-23, 26, 28).…”

“…As a result, these patients usually missed the best treatment timeline due to the misdiagnosis or delayed diagnosis. Here, 30 scarce cases presented cardiac tamponade (7)(8)(9)(10)(11)(12)(13)(14), cardiac mass (15)(16)(17)(18)(19)(20)(21)(22), myocardium hypertrophy (23)(24)(25)(26)(27)(28)(29)(30), or acute myocardial infarction (AMI) (31)(32)(33)(34)(35)(36) as the first sign of ALL were carefully reviewed, and we provided recommendations of management procedures for the diagnosis and treatment in these atypical ALL patients.…”