An unusual cardiac tumour found at post-mortem

This is a case of a 77-year-old man who was admitted to hospital complaining of palpitations, dizziness and sweating. During his hospital admission he was treated for various arrhythmias. An echocardiogram was performed which detected a possible infiltrative mass within the right ventricle but a subsequent echocardiogram showed right ventricular hypertrophy. Whilst awaiting further investigations, the patient self discharged and unfortunately died suddenly at home. An autopsy was conducted which showed a large tumour mass infiltrating the full wall thickness of the right ventricle with extension towards the right atria. The remaining heart structures were otherwise normal. Histological examination of the cardiac tumour showed a diffuse infiltration of atypical lymphoid cells with marked nuclear pleomorphism and mitotic activity. Immunohistochemistry confirmed that the atypical cells were lymphoid in origin and were strongly positive for CD45 and CD20. The proliferation index, determined using Mib-1 was focally high, and these findings were consistent with a diagnosis of diffuse large B-cell lymphoma. Primary cardiac lymphomas are rare and are associated with a high mortality, although some case reports have highlighted that early diagnosis and management can result in prolonged survival.

这是一位77岁男性的病例，他因心悸、头晕和出汗入院。住院期间，他因多种心律失常接受了治疗。进行了超声心动图检查，检测到右心室内可能有浸润性肿块，但随后的超声心动图显示右心室肥厚。在等待进一步检查时，患者自行出院，不幸在家中突然死亡。进行了尸检，结果显示一个大的肿瘤肿块浸润了右心室的全层厚度，并向右心房延伸。其余心脏结构正常。 心脏肿瘤的组织学检查显示非典型淋巴细胞弥漫性浸润，核多形性明显，有丝分裂活跃。免疫组织化学证实非典型细胞起源于淋巴细胞，CD45和CD20呈强阳性。使用Mib - 1测定的增殖指数局部较高，这些发现与弥漫性大B细胞淋巴瘤的诊断相符。 原发性心脏淋巴瘤很罕见，死亡率高，尽管一些病例报告强调早期诊断和治疗可延长生存期。