PMC8230158_01
Transthoracic echocardiography: Four-chamber view shows moderate pericardial effusion and a mass along the right ventricle (asterisk in a); after pericardiocentesis, the mass is better defined (asterisk in b); at parasternal short-axis view right coronary seems to be enclosed in the mass (c)
JCE-31-42-g001.jpg
PMC8230158_01_JCE-31-42-g001.jpg
F1
In the right chamber there was an infiltrating mass, not well defined because of the pericardial effusion [Figure 1a]. The next transthoracic TTE revealed a bulky infiltrating mass developing on the lateral wall of the right atria with irregular echogenicity, infiltration of the interventricular groove, the right ventricle, and partially of the right outflow tract; it had movable and jagged ends [Figure 1b]. The right coronary artery seemed traversing the tumor [Figure 1c].
Chest computed tomography shows heterogeneously enhancing infiltrating mass (*) with pleural (white circle) and pericardial (arrows) effusion (a), encasement of the right coronary artery (arrow, b)
JCE-31-42-g002.jpg
PMC8230158_01_JCE-31-42-g002.jpg
F2
In the next days, chest Computed Tomography (TC) confirmed the mass sized 70 mm x 50 mm x 75 mm, located along right cardiac chambers, infiltrating right ventricular outflow tract and even the aortic root with encasement of the right coronary artery [Figure 2].
Proliferation of atypical lymphoid cells in H and E, x40 (a), CD20 positivity, x40 (b), and high Ki67 proliferative index, x40 (c)
JCE-31-42-g003.jpg
PMC8230158_01_JCE-31-42-g003.jpg
F3
The definitive histopathological-immunohistochemical examination highlighted large atypical lymphoid cells CD20 positive, while the proliferative index Ki67/Mib 1 was 70%, compatible with cardiac high-grade B cell lymphoma [Figure 3].
Total body 18F-fluorodeoxyglucose positron emission tomography (coronal section) shows only cardiac uptake
JCE-31-42-g004.jpg
PMC8230158_01_JCE-31-42-g004.jpg
F4
For the definitive diagnosis of primitive cardiac tumor versus metastases, a 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) was performed and revealed intense uptake of the cardiac mass with no other areas of hypermetabolism [Figure 4].
Cardiac magnetic resonance at Steady state free precession (SSFP) sequences (*a) and 18F-fluorodeoxyglucose positron emission tomography (coronal section) show a reduction in tumor size (*b)
JCE-31-42-g005.jpg
PMC8230158_01_JCE-31-42-g005.jpg
F5
R-CHOP chemotherapy was started; 3 months later, cardiac magnetic resonance and 18F-FDG PET demonstrated a reduction in tumor size [Figure 5].