Published online Oct 6, 2022. doi: 10.12998/wjcc.v10.i28.10208
Peer-review started: April 22, 2022
First decision: May 30, 2022
Revised: June 11, 2022
Accepted: August 24, 2022
Article in press: August 24, 2022
Published online: October 6, 2022
Processing time: 158 Days and 0.9 Hours
The incidence of cardiac lymphoma is low, and it mainly occurs secondary to non-Hodgkin’s lymphoma, particularly diffuse large B-cell lymphoma. Here, we report a case of follicular lymphoma with cardiac involvement and severe heart failure as the sole clinical manifestation.
A 90-year-old male patient was first admitted to our hospital due to an accidentally discovered painless mass in the right lower abdomen. A biopsy of the mass revealed a follicular lymphoma. Positron emission tomography-computed tomography confirmed mild pericardial effusion, and echocardiography showed no structural abnormalities with normal ejection fraction at the time of diagnosis. The patient refused our recommendation of chemotherapy and was re-admitted 4 mo later due to heart failure. A series of subsequent echocardiographic examinations showed thickening of the left ventricular walls and increasing pericardial effusion over the following 2 mo. His heart failure exacerbated despite all symptomatic and supportive treatments. He passed away after an episode of aspiration pneumonia.
The diagnosis of cardiac lymphoma is difficult as its clinical manifestations are nonspecific, and prognosis is poor.
Core Tip: Most grade 1, 2, and 3A follicular lymphomas are indolent and treatment should be based on the patient’s basic condition. Here, we report a 90-year-old patient with follicular lymphoma, whose sole symptom was cardiac dysfunction that exacerbated rapidly into refractory stage IV cardiac failure. He responded poorly to all supportive and systematic treatments. Early detection of cardiac involvement in follicular lymphoma and timely intervention might be important in improving its prognosis.