title: Large B-cell lymphoma arising in cardiac myxoma or intracardiac fibrinous mass: a localized lymphoma usually associated with Epstein-Barr virus?
abstract: Primary cardiac neoplasms are rare. However, among them, cardiac myxoma is the most common tumor. In contrast, primary cardiac lymphoma within a cardiac myxoma is extremely rare and might be difficult to diagnose because of non-specific clinical manifestations. We report the case of a previously healthy 52-year-old man who presented with acute onset of transient dysarthria and left hemiplegia. A transthoracic echocardiography showed a 6×2.5-cm solid mass in the left atrium, which was subsequently resected. Histological, immunohistochemical, and molecular analyses revealed an EBV-associated CD30-positive large B-cell lymphoma with anaplastic morphology within a cardiac myxoma and fibrinous material. Staging studies showed no evidence of lymphoma elsewhere. The patient achieved complete remission and is alive 42 months after diagnosis, and did not receive chemotherapy. We discuss the clinical and pathologic features of lymphoma arising in cardiac myxoma or in intra-atrial fibrinoid mass and the potential role of IL-6 in its pathogenesis.
authors.affiliation: Department of Pathology, Edgardo Rebagliati Hospital, Lima, Peru. Electronic address: dr.cris85@yahoo.com.
authors.forename: Cristian
authors.initials: C
authors.lastname: Aguilar
authors.affiliation: Department of Oncology and Radiotherapy, Edgardo Rebagliati Hospital, Lima, Peru.
authors.forename: Brady
authors.initials: B
authors.lastname: Beltran
authors.affiliation: Department of Pathology, Edgardo Rebagliati Hospital, Lima, Peru.
authors.forename: Pilar
authors.initials: P
authors.lastname: Quiñones
authors.affiliation: Department of Pathology, Edgardo Rebagliati Hospital, Lima, Peru.
authors.forename: Tomas
authors.initials: T
authors.lastname: Carbajal
authors.affiliation: Department of Pathology, Edgardo Rebagliati Hospital, Lima, Peru.
authors.forename: Jorge
authors.initials: J
authors.lastname: Vilcapaza
authors.affiliation: Department of Pathology, Edgardo Rebagliati Hospital, Lima, Peru.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Yabar
authors.affiliation: Department of Cardiology, Edgardo Rebagliati Hospital, Lima, Peru.
authors.forename: Pedro
authors.initials: P
authors.lastname: Segura
authors.affiliation: Institute of Pathology and Comprehensive Cancer Center, University of Tübingen, Germany.
authors.forename: Leticia
authors.initials: L
authors.lastname: Quintanilla-Martinez
authors.affiliation: Department of Hematopathology, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Roberto N
authors.initials: RN
authors.lastname: Miranda
authors.affiliation: Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA.
authors.forename: Jorge J
authors.initials: JJ
authors.lastname: Castillo
mesh_terms: D006338:Heart Neoplasms / Q000473:pathology*; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009232:Myxoma / Q000473:pathology*; D009378:Neoplasms, Multiple Primary / Q000473:pathology*
keywords: B-cell lymphoma; Cardiac myxoma; Chronic inflammation; EBER; Epstein–Barr virus