PMC10043437_01
Thoracic CT-scan showing mediastinal lymphadenopathies (red arrows) and the left atrial mass (yellow stars) in axial view (A and B) and in coronal view (C). Presence of a bilateral pleural effusion and a thickened pericardium (B).
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F1
Then, a thoracic, abdominal and pelvic CT scan was performed and showed the cardiac mass associated with a mild pericardial effusion, hilar and mediastinal lymphadenopathy and bilateral moderate pleural effusion (Figure 1).
CMR showing a bulky mass extending throughout the left atrium, infiltrating the interatrial septum and right atrium, on cine imaging sequence (A), slightly hyperintense on fat-saturated T2-weighted imaging (B) with heterogeneous enhancement on late gadolinium enhancement sequences (C) with complete disappearance after 6 cycles of R-CHOP in the same sequences (D-F).
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CMR confirmed the presence of a bulky mass with a "cauliflower" appearance, extending throughout the entire left atrium, infiltrating the interatrial septum and the right atrium as well as the basal inferior and inferolateral walls of the left ventricle (Figure 2A). This mass appeared isointense on black blood spin echo T1-weighted imaging, slightly hyperintense on fat saturated T2-weighted imaging with a heterogeneous enhancement on late gadolinium enhancement (LGE) sequences (Figures 2B,C), suggestive of a malignant tumor. After setting the MR conditional pacemaker to DOO mode, follow-up CMR revealed complete disappearance of the cardiac mass (Figures 2D-F).
Hematoxylin and eosin stain: large lymphocytes cells with moderately abundant cytoplasm and oval nuclei containing several nucleoli corresponding to centroblasts.
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Prompt pathological analysis revealed the presence of a diffuse large B-cell lymphoma classified as germinal center B cell type (CD10+, BCL6+, MUM1+), with a double expression of MYC/BCL2 (Figure 3).