TITLE:
Non Hodgkin’s Lymphoma with Right Atrial Intra Cardiac Metastases
AUTHORS:
Gaind Saurabh, Nitin Kumar Kashyap, Mehsare Pranay Suresh, Niraghatam Harshavardhan, Nirupam Sekhar Chakraborty, Rahul Satarkar, Mudalsha Ravina, Shiva Thakur
KEYWORDS:
Diffuse Large B-Cell Lymphoma (DLBCL), Non-Hodgkin’s Lymphoma (NHL), Secondary Intracardiac Metastasis, Cardiogenic Shock, Immuno Histo Chemistry (IHC)
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.13 No.7,
July
19,
2023
ABSTRACT: Background: Diffuse Large B-Cell Lymphoma (DLBCL) is the most variant of
Non-Hodgkin’s Lymphoma (NHL) and also the most common variant with secondary
intracardiac masses. Case summary: 7 years old child presented to
emergency with acute decompensated cardiac failure, ascites and tender
hepatomegaly. 2D echo evaluation was suggestive of large intracardiac mass in
the right atrium almost completely obstructing Tricuspid valve orifice, gross
pericardial effusion and dilated Inferior Vena Cava (IVC). Emergency tumor excision
surgery was performed which revealed 4 × 4 cm pinkish firm mass arising from
anterior Tricuspid annulus which was completely excised. Child was extubated on
postoperative day (POD) 0 and was on minimal inotropic support. Ascites reduced
significantly on POD1 allowing abdominal palpation which revealed a mass in the
epigastric region. This prompted evaluation by pediatrician and oncology workup
suggestive of increased 18-Flouro Deoxy Glucose (18-FDG) uptake in the
mediastinum, abdomen, bilateral proximal thighs, all mediastinal lymph nodal
stations, bilateral lung hilar stations 10R, 10L involving all encasing the
heart and great vessels with pleural deposits, Celiac trunk, superior
Mesenteric Artery (SMA), Portal vein, IVC and abdominal aorta. Histo pathology
Examination (HPE) and Immuno Histo Chemistry (IHC) of intracardiac mass
revealed DLBCL which is metastatic in nature. Chemotherapy was started as per
(French American British Lymphomes Malins B) FAB LMB-96 protocol with the child
currently in the Induction phase having poor prognosis and less survival
interval. Conclusion: Surgery can be considered a treatment option for
metastatic intracardiac masses during emergency scenarios like cardiogenic
shock to relieve obstruction along the pathway of blood flow in the heart even
though we may not be able to completely excise the tumor surgically.