Case Report

Hodgkin’s Lymphoma Transformation into Diffuse Large B Cell Lymphoma Presented as a Right Atrial Mass: A Case Report

Abstract

Cardiac involvement can occur in lymphoma, with the right heart being predominantly affected. The prognosis for patients with cardiac involvement is poor. A 28-year-old man, with a 4-year history of Hodgkin’s lymphoma, presented with progressive shortness of breath and ascites. Chest X-ray (CXR) and CT scan revealed multiple masses in the mediastinum. To exclude a pulmonary embolism, the patient underwent CT angiography, which incidentally revealed a filling defect in the right atrium. Trans-esophageal echocardiography confirmed the presence of a mass in the right atrium. Surgery was performed to obtain samples of the mediastinal masses and the right atrium mass. Pathological results indicated that the nature of the right atrium mass was diffuse large B-cell lymphoma (DLBCL), suggesting that the Hodgkin’s lymphoma had transformed into DLBCL. The transformation of Hodgkin’s lymphoma to DLBCL can occur, and cardiac involvement is not common. Given that the transformation of Hodgkin’s lymphoma into DLBCL can occur many years after the initial diagnosis, the authors recommend follow- up of these patients, as the prognosis may be worse than for non-transformed subtypes.

[1] Thangamuthukumar KG, Karthikeyan S, Gnanavelu G, Swaminathan N, Venkatesan S. An unusual case of right atrial mass. J Indian Acad Echocardiogr Cardiovasc Imaging. 2018;2:80-1. https://doi.org/10.4103/jiae.jiae_50_17
[2] Goddard MJ. Cardiac tumours. Diagn Histopathol (Oxf). 2018;24(11):453-60. https://doi.org/10.1016/j.mpdhp.2018. 10.003
[3] O’Mahony D, Piekarz RL, Bandettini WP, Arai AE, Wilson WH, Bates SE. Cardiac involvement with lymphoma: a review of the literature. Clin Lymphoma Myeloma. 2008;8(4):249-5. https:// doi.org/10.3816/CLM.2008.n.034
[4] Roberts WC, Glancy DL, Devita VT Jr. Heart in malignant lymphoma (Hodgkin’s disease, lymphosarcoma, reticulum cell sarcoma and mycosis fungoides): a study of 196 autopsy cases. Am J Cardiol. 1968;22(1):85-107. https://doi. org/10.1016/0002-9149(68)90250-6
[5] Hsueh SC, Chung MT, Fang R, Hsiung MC, Young MS, Lu HF. Primary cardiac lymphoma. J Chin Med Assoc. 2006;69(4):169- 74. https://doi.org/10.1016/S1726-4901(09)70200-X
[6] Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG. Introduction to the 2015 World Health Organization classification of tumors of the lung, pleura, thymus, and heart. J Thorac Oncol. 2015 Sep;10(9):1240-2. https://doi. org/10.1097/JTO.0000000000000663
[7] Lam KY, Dickens P, Chan AC. Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies. Arch Pathol Lab Med. 1993 Oct;117(10):1027-31.
[8] Jeudy J, Burke AP, Frazier AA. Cardiac lymphoma. Radiol Clin North Am. 2016 Jul;54(4):689-710. https://doi.org/10.1016/j. rcl.2016.03.006
[9] Godfrey J, Leukam MJ, Smith SM. An update in treating transformed lymphoma. Best Pract Res Clin Haematol. 2018 Sep;31(3):251-61. https://doi.org/10.1016/j.beha.2018.07.008
[10] Kenderian S, Habermann T, Macon W, Ristow K, Ansell S, Colgan J, et al. Large B-cell transformation in nodular lymphocyte- predominant Hodgkin lymphoma: 40-year experience from a single institution. Blood. 2016;127(16):1960-1966. https:// doi.org/10.1182/blood-2015-08-665505
Files
IssueVol 8 No 5 (2023): September-October QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/crcp.v8i5.15254
Keywords
Hodgkin’s lymphoma large B cell lymphoma Transformation Right atrial mass
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Sardari A, Salehi M, Salahshour F, Mehrakizadeh A, Sattartabar B. Hodgkin’s Lymphoma Transformation into Diffuse Large B Cell Lymphoma Presented as a Right Atrial Mass: A Case Report. CRCP. 2024;8(5):181-184.