A Long Journey to the Truth: Primary Cardiac Lymphoma with Various Arrhythmias from Ventricular Tachycardia to Atrial Flutter

摘要

On May 11, 2010, a 43-year-old man visited our hospital with palpitations and dizziness for one year. Initial electrocardiogram (ECG) showed first and second degree atrioventricular block (Figure 1A and B). At first, transthoracic echocardiogram (TTE) was normal (Figure 2A). Over a 7-year period, ECG findings gradually proceeded and various arrhythmias developed including ventricular tachycardia (VT) (Figure 1C-F). TTE showed diffuse progressive ventricular and atrial wall thickening (Figure 2B and C). Finally, TTE expressed a huge mass in right atrial cavity (Figure 2D). A total of 3 transvenous endomyocardial biopsies were performed and all revealed no abnormal findings. Chest computed tomography (CT) showed huge cardiac masses and anterior mediastinal lymph node enlargement (Figure 3). He was initially considered as hypertrophic cardiomyopathy and then cardiac sarcoidosis. On April 5, 2017, anterior mediastinal lymph node excision biopsy was conducted and the pathology was malignant large B cell lymphoma (Figure 4). He was finally diagnosed with primary cardiac lymphoma (PCL). Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone chemotherapy was performed. On positron emission tomography-CT after 9 months of chemotherapy, 18F-fluorodeoxyglucose uptake significantly decreased (Figure 5) and VT no longer occurred. TTE findings became almost normal (Figure 2E).