PMC9923120_01
At diagnosis of lymphoma, a PET-CT scan and a biopsy were performed. (A-C) PET/CT revealed multiple enlarged lymph nodes in the middle and upper mediastinum and the maximum plane size was approximately 6.3 cm x 4.3 cm. There were masses showing infiltration around the ascending aorta and pulmonary artery. The SUVmax was 13.8. (D) PET/CT revealed the uncinate process of pancreas infiltration, with a diameter of about 2 cm and the SUVmax was 5.7. (E, F) Overall, there is no significant abnormal radiation uptake outside of the pancreas and mediastinal lymph nodes. (G)The hematoxylin-eosin staining revealed medium to large cells with irregular nucleus in the pancreas (original magnification 10 x). (H, I) The hematoxylin-eosin staining revealed medium to large cells with irregular nucleus in the mediastinum (H:original magnification 10 x; G:original magnification 20 x).
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Positron emission tomography CT (PET-CT) revealed abnormally increased fluorodeoxyglucose (FDG) uptake in the middle and upper mediastinum lymph nodes with a maximum lymph node size of 6.3 x 4.3 cm and the maximum standard uptake value (SUV max) was 13.8, the boundary between cardiovascular vessels and masses was not clear ( Figures 1A-C, E, F ). The pancreatic uncinate showed a round focus with high FDG uptake of approximately 2.0 cm in diameter, the SUVmax was 5.7 ( Figures 1D-F ).
The patient experienced dyspnea and had a refractory bilateral pleural effusion after receiving multi-line chemotherapy. Transthoracic echocardiography showed the heart infiltrated by lymphoma. (A) Long axis section of left ventricle showing a slight hypoechoic mass in the anterior wall of the left atrium. (B) Lateral wall of left atrium and left atrial appendage were infiltrated. (C, D) Four-chamber view showed pulmonary vein infiltration. Cardiac ventricular opacification (CVO): (E, F) An irregular mass was present at the entrance of pulmonary veins in the left atrium with rapid irregular perfusion and complete enhancement. (LV: Left Ventricle; RA: Right Atrium; RV: Right Ventricle; LA: Left Atrium).
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Transthoracic echocardiography left ventricular contrast echocardiography (LVO) and myocardial contrast echocardiography (MCE) detected heart metastases ( Figures 2A-F ).
Statistical analysis of the data in the literature review and the timeline of disease status and corresponding treatment regimens of our patient. (A) Timeline of disease status and corresponding treatment regimens. (B) Pie chart of tissue type composition of secondary cardiac lymphoma. (DLBCL, diffuse large B-cell lymphoma; MZL, marginal zone lymphoma; MCL, mantle cell lymphoma; T-cell: T cell lymphoma). (C) Kaplan-Meier survival curves for secondary cardiac lymphomas comparing DLBCL with other cancers included in the statistics. (CI, confidence interval).
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The timeline of clinical treatment and the state of the disease are shown in  Figure 3A .