Precursor T-Cell Lymphoblastic Lymphoma Presenting as Cardiac Tamponade in a 25-Year-Old Male: A Case Report and Review of Literature

Abstract

Precursor T-cell lymphoblastic lymphoma (LBL) and T-cell acute lymphoblastic leukemia (ALL) are considered same disease with different clinical presentations. Clinically, a case is defined as lymphoma if there is a mass lesion in the mediastinum or elsewhere and < 25% blasts in the bone marrow. Whereas, bone marrow with > 25% blasts with or without mediastinal masses is classified as T-cell ALL. Mediastinal masses caused by T-cell LBL can lead to complications such as superior vena cava syndrome, tracheal obstruction, pericardial effusion and tamponade. We report an unusual case of a 25-year-old male with no significant past medical history, who presented with clinical features of cardiac tamponade. Work-up revealed a massive pericardial effusion and a mass arising in the anterosuperior mediastinum. Patient underwent an emergent subxiphoid pericardial window and approximately 1 L of hemopericardium was drained. Histopathology (pericardial tissue) and flow cytometry on the pericardial fluid were compatible with a precursor T-cell LBL. Although pericardial involvement by lymphoma/leukemia is a very rare complication, cases have been reported with both lymphoma and acute/chronic leukemia. Our paper highlights cardiac tamponade as one of the life-threatening complications associated with a precursor T-cell LBL.

Restrictive physiology masked by cardiac tamponade

“…[ 3 ] Literature review reveals only a few published reports of T-cell lymphoma with cardiac tamponade. [ 9 ] Although dyspnea is common to both pericardial and myocardial involvement, associated orthopnea or PND as in our case is not specific for either of these. As it is difficult to differentiate based on presenting symptoms alone, a detailed echocardiography reassessment is warranted after the pericardiocentesis to help differentiate between these entities.…”

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.…”

microRNAs involved in T‐cell development, selection, activation, and hemostasis

“…Furthermore, downregulation of CDKN1c and upregulation of E2F1 in T‐cell lymphoblastic neoplasm (T‐LBL) have been reported (López‐Nieva et al, 2018). T‐LBL is an aggressive hematological cancer in childhood (Kapur & Levin, 2014). According to a recent study, the upregulation of miR‐221 and miR‐222 contributes to the suppression of CDKN1c.…”