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      Successful Chemotherapy Treatment for a Tricuspid Valvular Stenosis Patient due to Right Ventricular Lymphoma

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          Abstract

          Background

          This study presents a patient diagnosed with tricuspid valvular stenosis due to right ventricular lymphoma, who was treated successfully.

          Case presentation

          A 66-year-old man with a history of worsening shortness of breath during activity for the last three weeks sought medical attention. The patient later experienced swelling in the extremities, fluid build-up around the lungs and abdominal fluid accumulation, with no reported chest pain, fever, or weight loss. An echocardiogram found a mass in the lateral wall near the tricuspid valve of the right ventricle, leading to moderate tricuspid stenosis. The cardiac magnetic resonance imaging (MRI) revealed a lumpy, poorly defined mass that invaded the heart muscle and displayed varied enhancement after contrast administration. Suspicion arose for a malignant tumour or metastatic lesion due to its features and contrast uptake capability. A percutaneous biopsy was carried out on the mass in the right ventricle to confirm the diagnosis. The pathology report indicated a diagnosis of non-Hodgkin’s lymphoma. After being diagnosed, the patient underwent chemotherapy using the R-CHOP regimen. Over time the symptoms improved, and echocardiograms revealed a decrease in the size of the tumour. After undergoing six rounds of chemotherapy, a cardiac MRI four months later showed no signs of a tumour. After that, the patient resumed their regular activities.

          Conclusion

          Right ventricular tumours are mostly malignant lesions and often have an inferior prognosis. Early diagnosis with imaging techniques and myocardial biopsy is necessary to deliver life-saving treatment quickly.

          LEARNING POINTS

          • Right ventricular tumours are mostly malignant lesions and often have an inferior prognosis.

          • Early diagnosis with imaging techniques and myocardial biopsy is necessary to deliver life-saving treatment quickly.

          • Right ventricular lymphoma is a sporadic tumour, but the prognosis is favourable if detected in time.

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          Most cited references16

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          Primary cardiac lymphoma: an analysis of presentation, treatment, and outcome patterns.

          S Cho, Adam M. Petrich, Henny Billett (2011)
          Primary cardiac lymphoma (PCL) represents a rare subset of non-Hodgkin lymphoma, characterized by poor outcomes. The authors aimed to construct a framework of known clinical presentations, diagnostic features, disease complications, treatment, and outcomes to improve prognostication. Individual patient data were obtained from defined cases of PCL (1949-2009) and systematically analyzed. The authors report results of a review of 197 cases of PCL, with half of all cases reported since 1995. Survival was affected by 4 factors: immune status, left ventricular involvement, presence of extra-cardiac disease, and arrhythmia. Median overall survival (OS) for immunocompromised and immunocompetent was 3.5 months (m) and not reached, respectively (HR 0.29, 95% CI, 0.13-0.68; P = .004). LV involvement was uncommon (26%) and associated with an OS of only 1 m, whereas patients free of LV involvement had a median OS of 22 m (HR 0.28, 95% CI, 0.12-0.64; P = .002). Patients with extracardiac disease had shorter median OS compared with those without (6 m vs 22 m, HR 0.49, 95% CI, 0.26-0.91; P = .02). Those patients with an arrhythmia of any type had a median OS that was not reached (n = 55), whereas those without rhythm disturbances (n = 41) had median OS of 6 m (HR 0.51, 95% CI, 0.29-0.91; P = .024). Overall response rate to therapy was 84%, with long-term OS over 40%. The current study presents the largest analysis of PCL to date. The data demonstrate that PCL is now more frequently diagnosed premortem and appears to have reasonable response rates. Lack of LV involvement and the presence of arrhythmias are associated with improved survival. Copyright © 2010 American Cancer Society.
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            Cardiac Tumors

            Ioannis A. Paraskevaidis, Christos Michalakeas, Constantinos H. Papadopoulos … (2011)
            Cardiac tumors represent a relatively rare, yet challenging diagnosis. Secondary tumors are far more frequent than primary tumors of the heart. The majority of primary cardiac tumors is benign in origin, with primary malignant tumors accounting for 25% of cases. Metastatic tumors usually arise from lung, breast, renal cancer, melanomas, and lymphomas. Clinical manifestations of cardiac tumors depend on the size and location of the mass and the infiltration of adjacent tissues rather than the type of the tumor itself. Echocardiography is the main diagnostic tool for the detection of a cardiac mass. Other imaging modalities (C-MRI, C-CT, 3D Echo) may offer further diagnostic information and the establishment of the diagnosis is made with histological examination. Management depends on the type of the tumor and the symptomatology of the patient.
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              Primary cardiac lymphoma: two cases and a review of literature

              Karolis Jonavicius, Kestutis Salcius, Raimundas Meskauskas … (2015)
              Background Primary cardiac lymphoma is one of the rarest tumours of the heart. It belongs to the extra-nodal non-Hodgkin’s lymphomas. The most common type of this tumour is diffuse large B cell lymphoma. Usually, right atrium and right ventricle are involved. This tumour is fatal unless diagnosed and treated in time. In this article two female patients who were diagnosed with primary cardiac lymphoma and treated at our clinic are described. The first patient went to remission after the treatment, while the second patient died. The goals of this article are to show the difficulties of diagnosing and treating this disease, the role of cardiac surgery in its treatment and to raise awareness of this disease. Case reports In this article two female patients who were diagnosed with primary cardiac lymphoma and treated at our clinic are described. The first patient went to remission after the treatment, while the second patient died. Conclusions Primary cardiac lymphoma is a very rare disease. At the moment the most effective treatment is chemotherapy. Palliative surgery may be necessary to correct hemodynamics when venous blood flow to the lungs is disturbed.
              Article 0 comments Cited 30 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eur J Case Rep Intern Med
                Title: European Journal of Case Reports in Internal Medicine
                Publisher: SMC Media Srl
                ISSN (Electronic): 2284-2594
                Publication date Collection: 2024
                Publication date (Electronic): 25 March 2024
                Volume: 11
                Issue: 4
                Electronic Location Identifier: 004451
                Affiliations
                Department of Cardiovascular Intensive Care Unit, 108 Central Military Hospital, Hanoi, Vietnam
                Author notes
                Corresponding author: Tran Quoc Quy e-mail: tranquy.bv108@ 123456gmail.com
                Article
                Publisher ID: 4451
                DOI: 10.12890/2024_004451
                PMC ID: 10997397
                PubMed ID: 38584896
                SO-VID: 4477c814-afc8-4f78-abce-85222058116e
                Copyright © © EFIM 2024
                License:

                This article is licensed under a Commons Attribution Non-Commercial 4.0 License

                History
                Date received : 09 March 2024
                Date accepted : 12 March 2024
                Categories
                Subject: Article

                Keywords: tricuspid valvular stenosis,right ventricular lymphoma,chemotherapy
                Data availability:
                Keywords: tricuspid valvular stenosis, right ventricular lymphoma, chemotherapy

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