PMC9544802_01
Echocardiography progression of the patient. (A) The patient underwent echocardiography 2 months prior to the present hospitalization, and no remarkable abnormality was revealed. (B, C) Regular TTE and myocardial contrast echocardiography showing tumor extending from the right atrium to the right ventricle through the tricuspid valve. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; Ao, aorta; RVOT, right ventricular outflow tract; PLAX, parasternal long axis; PSAX, parasternal short axis; AV, aortic valve.
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On day 2 of hospitalization, TTE and transesophageal echocardiography (TEE) showed a mass measuring 62 mm x 39 mm originating from the right atrium and right ventricle (Figure 1).
Multimodality medical imaging diagnosis and histopathological examination of the mass. (A) Computed tomography obtained 2 months before showed no mass in the right heart. (B, C) Cine MRI demonstrated a large infiltrating mass extending in the right atrium and ventricle, occupying most of the right atrium. (D-F) Left ventricular opacification, TEE, and 3D ultrasonic imaging of the morphological feature of the mass. (G-O) Histological examination of the lymph node, H&E, CD20, BCL6, CD3, CD5, MUM1, CD10, CD30, and c-Myc, (P) EBV infection was identified using in situ hybridization (ISH) for the detection of EBV-encoded small RNA (EBER) EBER staining. IVS, interventricular septum; TEE, transesophageal echocardiography; EBV, Epstein-Barr virus.
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It was a lobulated, poorly mobile mass that partially occupied the right atrium and partly occupied and occluded the tricuspid, hampering the blood flow to the right ventricle, even though a chest CT scan showed no mass in the right heart 2 months before (Figure 2A). It also revealed the mass infiltration of the surrounding myocardium, with mild pericardial and pleural effusion (Figures 2B,C). Myocardial contrast echocardiography and left ventricular opacification revealed that a large filling defect invaded the anterior wall of the right atrium and right ventricle (Figures 2D-F). The tissue collected from the lymph node showed a diffuse infiltrate consisting predominantly of large atypical lymphoid cells (Figure 2G) and blasts of B-cell lineage (CD20, B-cell marker) (Figure 2H); other immunohistochemical pictures, such as BCL6, CD3, CD5, MUM1, CD10, CD30, and c-Myc, were all negative (Figures 2I-O). The presence of Epstein-Barr virus (EBV) infection was identified using in situ hybridization (ISH) for the detection of EBV-encoded small RNA (EBER) in biopsy tissue samples, which was negative as well (Figure 2P). A diagnosis of DLBCL was made (Figures 2G-I).