Cytomorphologic diagnosis of malignant lymphoma arising in the heart - A case report

BACKGROUND: Primary malignant lymphoma of the heart is extremely rare. Beca use its clinical signs and symptoms are typically nonspecific, it is often very difficult to detect cardiac involvement while the patient is alive. We describe a case of malignant lymphoma involving predominantly the heart an d pericardium and diagnosed by pericardiac effusion cytology antemortem. CASE: An 83-year-old woman presented with dyspnea on exertion. Echocardiogr aphy revealed a low-echoic tumor mass close to the right ventricular wall a nd massive pericardiac effusion. Diagnosis of diffuse large B-cell lymphoma was made by cytomorphologic examination and flow cytometry of the tumor ce lls obtained from the effusion. Although chemotherapy was instituted immedi ately, the patient died of progressive heart failure. Diffuse large B-cell lymphoma predominantly involving the intracardiovascular region was confirm ed at autopsy. CONCLUSION: From the experience in this case, we conclude that cytopatholog ic examination of sonographically guided aspiration of the cardiovascular r egion is very useful for antemortem diagnosis of primary malignant lymphoma of the heart.