LABORATORY DEPT., SHAHEED RAJAIE CARDIOVASCULAR MEDICAL AND RESEARCH CENTER, IRAN UNIVERSITY OF MEDICAL SCIENCES, TEHRAN, IRAN
A 62-year-old man was referred to our hospital with dyspnea. Preliminary studies revealed multiple masses in the right ventricle, epicardium, and pericardium; no lymphadenopathy or organomegaly was, however, detected.
The patient underwent a surgical operation with the diagnosis of a cardiac mass. Multiple, firm, whitish-yellow nodules with extension to the epicardial fat were excised, and the defect was repaired with an extensive pericardial patch. The myocardium was infiltrated by discohesive sheets of malignant round cells that had a high nucleocytoplasmic (N/C) ratio, scanty cytoplasm, and a coarse chromatin pattern.
The diagnosis was further confirmed by a panel of immunohistochemistry markers; the neoplastic cells were positive for CD 45 and CD 20.
Primary lymphomas originating from the heart and pericardium are extremely rare and constitute only 1.6 percent of cardiac neoplasms. They arise mainly from the right chambers and may be of low, intermediate, or high grade. The majority are of B-cell nature. No association with viruses has been established. Cytology is diagnostic in the effusions of the pericardium. Unfortunately, prognosis is grim due to delayed diagnosis.