Clinical Case ReportLarge B-cell lymphoma arising in cardiac myxoma or intracardiac fibrinous mass: a localized lymphoma usually associated with Epstein–Barr virus?
Introduction
Primary cardiac neoplasms are rare. About 80%–90% of primary cardiac tumors are benign [1], [2], and of these the most common are cardiac myxomas, which usually arise in the left atrium [1], [2], [3]. Most patients present with one or more symptoms of the classic triad of embolic events, intracardiac flow obstruction and constitutional symptoms [2], [3], [4], and about 10% of patients are asymptomatic [3].
Primary cardiac lymphoma is a rare neoplasm, accounting for 2% of all primary cardiac tumors, and affects mainly the right chambers of the heart [5]. During the last decade, isolated cases of lymphoproliferative neoplasms within a cardiac myxoma [6], [7], [8], [9], [10], [11], [12], or intracardiac fibrinoid masses [13], [14], [15], [16], [17], [18], [19], occasionally have been reported in the medical literature; most of these reports show an association with Epstein–Barr virus (EBV) infection and show a local production of inflammatory cytokines.
We report the clinical, histologic, phenotypic, and molecular findings of a patient with large B-cell lymphoma associated with EBV infection, discovered incidentally within a myxomatous and fibrinoid cardiac mass.
Section snippets
Case presentation
A 52-year-old man without any significant past medical history was admitted to our hospital with acute onset of transient dysarthria and left hemiplegia, after a soccer game. On cardiac examination, he had regular rate and rhythm. No murmurs or gallops were audible on auscultation. Laboratory tests showed increased C-reactive protein (4.3 mg/dl) and lactate dehydrogenase levels (538 U/l). Complete blood counts and metabolic panel were normal. Computed tomography (CT) scan of the head suggested
Discussion
We report an immunocompetent patient who presented with an incidental CD30-positive diffuse large B-cell lymphoma (DLBCL) arising within a left heart atrium myxomatous and fibrinoid mass. The patient had surgical removal of the mass, and did not need chemotherapy; patient has no evidence of disease 42 months after diagnosis. The association of the DLBCL with EBV type III latency without an associated underlying immunosuppression of the patient, suggests that unknown mechanisms of local
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Funding: Authors disclose no funding sources.