Authored by Rios Dueñas Giovanny*
Abstract
Primary heart tumors are very rare. Reyne et al. reported a prevalence of 0.02% for heart tumors in 22 autopsies [1]. Primary heart lymphomas are even more rare, with a prevalence between heart tumors from 1 to 2% and 0.5% of all lymphomas [1,2]. We will report one case of a 69-year-old woman with a mass in the right atrium, with hemodynamic compromise, with the histological finding of a primary heart diffuse type B lymphoma.Keywords:Heart lymphoma; Heart tumors; Diffuse type B Lymphoma; Cardiac lymphoma; diffuse large B-cell lymphoma; Cardiac tumors
Summary
Primary tumors of the heart are quite rare. In a series of 22 autopsies conducted by Reynen et al. [1] found a prevalence for cardiac tumors of 0.02%. Primary cardiac lymphoma is even rarer, with a prevalence between cardiac tumors of 1% to 2% and 0.5% of all lymphomas [1,2]. The case of a 69-year-old woman with a diagnosis of intracardiac mass will be reported, which in the histological studies of this mass evidenced compromise by primary cardiac lymphoma.Case Report
This is a 69-year-old patient who consulted the emergency department of San Ignacio Hospital for presenting a clinical picture of functional class deterioration, progressive dyspnea at medium and low effort, associated with a palpitation sensation. In the interrogation without significant background. It is evaluated by the emergency department, which, in view of the characteristics of the clinical picture and the presence of indirect signs of heart failure, requests computerized axial tomography with a pulmonary artery protocol to rule out pulmonary embolism and thromboembolism. This study reports a moderate pericardial effusion associated with the presence of a mass that occupies 90% of the right atrium with extension to the superior and inferior vena cava. Given these findings, an assessment was requested by the cardiology service, who performed a dynamic study with a trans-esophageal echocardiogram in which the mass with soft tissue echodensity, 7.5 x 55mm, with compromise of the arrival of the superior cava, was demonstrated. Endoluminal compromise of 50 to 95% in the atriocaval junction. In addition to pericardial effusion in moderate amount without echocardiographic signs of cardiac tamponade. With these findings, it is taken to the surgical medical board in which the cardiovascular surgery service considers a candidate for surgical intervention for extraction of atrial mass and pathological study of it. Medium sternotomy is performed; Dissection of fibrotic pericardium and opening thereof, pericardial effusion is identified in the images of bloody characteristics. Cardiopulmonary bypass is established; arterial cannulation of the aortic root, venous cannulation by superior vena cava and by right femoral vein due to the tumor invasion presented in the inferior vena cava. Right atrial opening, without aortic clamping. Dissection of right atrium mass is started without complete extraction, given the presence of infiltration to the posterior wall of the right atrium, superior cava, inferior cava, interatrial septum and tricuspid valve. Given the unresectability is considered auriculorrhaphy with cardiovascular prolene 4.0 in 2 planes.Removal of aortic clamp and cardiopulmonary bypass output without complications. Aortic clamp and cardiopulmonary bypass times, 17 min and 32 min respectively. The patient is transferred to the intensive care unit for surveillance. In the results of the histological studies, diffuse large B-cell lymphoma, primary of the heart, positive for CD45, CD20 and Bcl16, cellular proliferation index (Ki67) of 70% was identified. Negative for Bcl2, abundant CD68 positive histiocytes and CD3 positive T lymphocytes.
The pathology shows Diffuse B-cell lymphoma activated phenotype.
• Tumor cells of high grade of malignancy positive for CD20, Bcl6 and MUM-1 with a cell proliferation index (Ki67) of 70%. They are negative for Bcl2 and CD10.
• IAE Stadium
• Cardiac Commitment (POP resection of cardiac tumor (07/31/2017).
• High-intermediate risk (IPI 3).
Echocardiography:(07/24/17) Moderate eccentric hypertrophy, LVEF 60%, AD dilated.
It goes through its postoperative period without complications. The cardiac block is reversed, and it is discharged. Later in controls the patient presented after the second click of chemotherapy, heart block. A definitive transvalent unicameral pacemaker was implanted, which is functional. The patient has been followed for 2 years. She received for treatment 6 cycles of chemotherapy, R-CHOP21 protocol x 6 cycles. Lead a life with acceptable quality. It is independent in its functions. It is in the process of recovering secondary alterations to chemotherapy Figure 1.
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