Management of diffuse large B-cell lymphoma with cardiac and extra-cardiac locations

[摘要] A 71-year-old man presented with 6 kg weight loss since 4 monthsand asthenia. He also had mild cough for a few weeks, sudden stabbingthoracic pain recurring at rest without radiation, and no dyspnea.The patient had a history of chronic weaned alcoholism, active smoking, hypertension on triple therapy, and professional exposure topaint. The last transthoracic echocardiography (TTE) performed 6months before his admission showed an isolated septal hypertrophy at13 mm without supplementary cardiac abnormalities. At admission,hemoglobin was 138 g/L, platelet and leukocyte counts were 369 ×109/L and 10.1 × 109/L, respectively, C-reactive protein was 51 mg/L,lactate dehydrogenase (LDH) was 8.57 µkat/L, and troponin I was 86.6µg/L. Neither clinical nor electrocardiogram additional abnormalitieswere identified. TTE exhibited a significant necrotic intracardiac mass.Computed tomography (CT) highlighted an 80 × 80 mm infiltratingheart mass centered on the right atrioventricular septum with extension to the tricuspid ring (Figure 1, left image), a mediastino-hilarlymphadenopathy, a 15 mm right posterobasal pulmonary nodule, anda thin layer of right pleural effusion. A biopsy of the mediastinal lesionby endoscopic ultrasound revealed large B cells, strongly positive forCD20 antigen as well as CD19, CD5 (low intensity), CD10, CD38,CD79b, and FMC7 marker proteins with a Ki-67 of 70%. Althoughbiopsy was not large, the pathological diagnosis suggested a diffuselarge B-cell lymphoma.