Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2022; 10(28): 10208-10213
Published online Oct 6, 2022. doi: 10.12998/wjcc.v10.i28.10208
Follicular lymphoma with cardiac involvement in a 90-year-old patient: A case report
Yi-Xuan Sun, Jia Wang, Ji-Heng Zhu, Wei Yuan, Lin Wu
Yi-Xuan Sun, Jia Wang, Ji-Heng Zhu, Lin Wu, Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Wei Yuan, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Author contributions: Sun YX and Wu L wrote the manuscript; Wang J, Zhu JH, and Yuan W contributed to the acquisition of case information; Sun YX obtained the funding; Wu L summarized the case; All authors approved the final version to be published.
Supported by National Natural Science Foundation of China, No. 81800759.
Informed consent statement: Written informed consent for this case report was obtained from the patient’s next of kin.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lin Wu, MD, Chief Physician, Doctor, Department of Geriatrics, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China. wu.lin@zs-hospital.sh.cn
Received: April 22, 2022
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

The diagnosis of cardiac lymphoma is difficult as its clinical manifestations are nonspecific, and prognosis is poor.

Keywords: Follicular lymphoma; Cardiac lymphoma; Chemotherapy; Heart failure; Elderly patient; Case report

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.