title: T-cell prolymphocytic leukemia with extensive cardiovascular infiltrate leading to multiple myocardial infarctions and cardiac death.
abstract: Lymphocytic neoplasm involving the heart is not common and usually presents with pericardial effusion or focal myocardial infiltration. Myocardial infarctions due to leukemic infiltration of the coronary arteries are rarely reported. We present the case of a 52-year-old Guatemalan man with a one-year history of untreated T-cell prolymphocytic leukemia. He was admitted to our hospital for chemotherapy and evaluation of a pulmonary cavitary lesion by wedge resection. During sedation, the patient experienced acute respiratory failure and hypovolemic shock, from which he could not be resuscitated. Autopsy revealed that leukemic cells extensively infiltrated the aorta, myocardium, and coronary arteries. The lumina of the 3 major coronary artery branches showed 70% to 95% stenosis, with multifocal remote myocardial infarctions. Tumor cells were also detected in the lungs and other organs. The acute cardiorespiratory insufficiency secondary to leukemia-particularly the extensive infiltration of the coronary arteries and myocardium, and the multiple myocardial infarctions-eventually resulted in cardiac death.
authors.forename: Hong
authors.initials: H
authors.lastname: Cheng
authors.forename: Tatyana
authors.initials: T
authors.lastname: Feldman
authors.forename: Yasmeen
authors.initials: Y
authors.lastname: Butt
authors.forename: Kar F
authors.initials: KF
authors.lastname: Chow
authors.forename: Xiao Yan
authors.initials: XY
authors.lastname: Yang
authors.forename: Pritish K
authors.initials: PK
authors.lastname: Bhattacharyya
authors.forename: David C
authors.initials: DC
authors.lastname: de Vinck
mesh_terms: D001344:Autopsy; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D023921:Coronary Stenosis / Q000175:diagnosis / Q000209:etiology*; D003331:Coronary Vessels / Q000276:immunology / Q000473:pathology*; D017809:Fatal Outcome; D006338:Heart Neoplasms / Q000150:complications* / Q000276:immunology / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D015461:Leukemia, Prolymphocytic, T-Cell / Q000150:complications* / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology*; D009361:Neoplasm Invasiveness; D012008:Recurrence
chemical_list: D014408:Biomarkers, Tumor
keywords: Aorta; autopsy; coronary arteries; heart neoplasms/secondary/etiology; leukemia, T-cell prolymphocytic; leukemia, lymphoid/pathology; myocardial infarction