PMC10050578_01
Electrocardiographic findings before (A) and after (B) treatment. The blue arrows indicate the patient's blocked P-wave and the red arrows indicate the P-wave in sinus rhythm.
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fig1
The initial electrocardiogram (ECG) revealed a third-degree AVB, complete right bundle branch block, and junctional escape (Figure 1A). As the patient's cardiac symptoms faded and AVB disappeared (Figure 1B), a standard R-CDOP regimen was initiated (rituximab, 600 mg on day 0; cyclophosphamide, 1 g on day 1; doxorubicin liposomes, 20 mg on day 1; doxorubicin liposomes, 40 mg on day 2; vincristine, 4 mg on day 1; prednisone, 60 mg on days 1-5).
Transthoracic echocardiography (TTE) findings pre- and post-chemotherapy. (A) Pre-chemotherapy TTE revealing filling of the coronary sinus with inhomogeneous echogenic material measuring approximately 21.4 mm x 68.3 mm. (B) TTE after the second cycle of chemotherapy showing filling of the coronary sinus with inhomogeneous echogenic material measuring approximately 22.5 mm x 43.4 mm are shown.
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Transthoracic echocardiography (TTE) showed cardiac occupancy, left ventricular diastolic dysfunction, and pericardial effusion (Figure 2A). Chest tightness and wheezing weakness were relieved after treatment, and echocardiography showed that the neoplasm on the pericardium also decreased in size (Figure 2B).
18F-fluorodeoxyglucose (FDG) positron emission tomography computed tomography (PET-CT) indicated multiple soft tissue nodules/masses with high FDG uptake in the pericardial cavity and a number of lymph nodes with high FDG uptake in the mediastinum.
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fig3
The patient was later admitted to the Department of Cardiology of our hospital with third-degree AVB and cardiac occupancy. 18F-fluorodeoxyglucose (FDG) positron emission tomography computed tomography (PET-CT) indicated the presence of multiple soft tissue nodules/masses in the pericardial cavity and high FDG uptake in the mediastinal lymph nodes, both suggesting a high probability of malignant lesions and possibly lymphoma (Figure 3).
Pericardial biopsy showing irregular lymphocyte infiltration. (A) The hematoxylin and eosin (H&E)-stained tissues (x400) and (B-F) CD20 (+), c-Myc (2+, 40%), Bcl-2 (+), Bcl-6 (+), and Ki-67 (+) immunohistochemistry assays (x400) are shown.
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In situ hybridisation revealed that cells were Epstein-Barr virus encoded RNA negative (Figure 4).