Diagnosis and treatment of primary cardiac lymphoma in an immunocompetent 27-year-old man

Background: Primary cardiac lymphomas (PCL) represent extremely rare cardiac tumors which are accompanied by poor prognosis, unless they are timely diagnosed and treated. Despite the rarity of Primary cardiac lymphomas, they should always be kept in mind in the differential diagnosis of cardiac tumors. At the moment the most effective treatment of primary cardiac lymphomas is chemotherapy.

Case presentation: A 27-year-old, immunocompetent man who presented to our hospital due complaining for one week from left inframammary stitching chest pain increase with inspiration, No dyspnea or palpitations. General and cardiac exams were free.

Multi-modality imaging demonstrated a large intracardiac tumor related to the posterior aortic wall and centered on the interatrial septum and protrude through the SVC, which was proven by biopsy, to be a Primary cardiac lymphoma(PCL). The patient received targeted chemotherapy including rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (RCHOP) which led to marked reduction of the tumor size and 18-FDG PET/CT scan showed no evidence of FDG avid metabolically active lesions.

No reported complications related to chemotherapy with no relapse over a 15-month follow-up period.

Conclusions: Cardiac tumors may present by non-specific manifestations. Primary cardiac lymphoma shows a poor prognosis, unless they are treated in the early stages. So, timely diagnosis is imperative. At the moment the most effective treatment is chemotherapy. Keywords: Primary cardiac lymphoma, Imaging, Chemotherapy.