title: Aggressive extensive cardiac mass in an HIV-1-infected patient: should we go for comfort therapy?
abstract: Cardiac masses are rare, the differential diagnosis includes infections with vegetations or abscesses, neoplasms, thrombi, and structural abnormalities. A pathology specimen is essential in therapeutic strategy planning for a cardiac mass, also if the primary imaging findings look dramatic at the start. Even in an inoperable setting, a life-saving therapy might be available. We report a case of a 49-year-old man, known with HIV-1, who was several times admitted with pericarditis. Now he was hospitalized with progressive lower limb edema, atrial fibrillation and detection of a giant cardiac mass in left and right atrium with infiltration of surrounding tissues. Given the extent and invasiveness of the mass, he was inoperable. Biopsy specimen was obtained and staging was performed by PET-CT scan. The diagnosis of stage IV Burkitt lymphoma with predominant extranodal cardiac involvement was withheld wherefore promptly aggressive therapy was started according to the GMALL B-NHL86 protocol. The therapy was downgraded to R-CHOP due to tolerance problems. He achieved a complete remission and during follow-up no relapse was detected.
authors.affiliation: a Cardiology Department , University Hospital Ghent , Ghent , Belgium.
authors.forename: Delphine Mtf
authors.initials: DM
authors.lastname: Vervloet
authors.affiliation: a Cardiology Department , University Hospital Ghent , Ghent , Belgium.
authors.forename: Michel
authors.initials: M
authors.lastname: De Pauw
authors.affiliation: a Cardiology Department , University Hospital Ghent , Ghent , Belgium.
authors.forename: Laurent
authors.initials: L
authors.lastname: Demulier
authors.affiliation: b Cardiology Department , Jan Yperman Hospital , Ieper , Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Vercammen
authors.affiliation: c General Internal Medicine and Nephrology Department , Jan Yperman Hospital , Ieper , Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Terryn
authors.affiliation: d Hematology Department , University Hospital Ghent , Ghent , Belgium.
authors.forename: Eva
authors.initials: E
authors.lastname: Steel
authors.affiliation: e General Internal Medicine Department , University Hospital Ghent , Ghent , Belgium.
authors.forename: Linos
authors.initials: L
authors.lastname: Vandekerckhove
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001706:Biopsy; D002051:Burkitt Lymphoma / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006338:Heart Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D000070659:Patient Comfort; D000072078:Positron Emission Tomography Computed Tomography; D011241:Prednisone / Q000627:therapeutic use; D012074:Remission Induction; D000069283:Rituximab; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Burkitt lymphoma; Cardiac catheterization; Cardiovascular; Diagnostic techniques; HIV-1; Heart neoplasm