Among primary malignant tumors of the heart, primary cardiac lymphomas are extremely rare. Early diagnosis is crucial in primary cardiac lymphoma cases as its non-specific symptoms often lead to delayed diagnosis and poor prognosis. In this case report, we presented
a challenging case of primary cardiac lymphoma that was noticed during echocardiography of a patient admitted with acute myocardial infarction. A 32-year-old man was admitted to the emergency department with acute anterior ST-elevated myocardial infarction. His
angiogram revealed an acute occlusion in the proximal left anterior descending artery with otherwise normal coronary arteries. After the total occlusion was passed with a guidewire, only a dense thrombus was observed. Therefore, an embolic source was suspected. Echocardiography revealed a giant mass (6 cm × 2.5 cm) attached to the interatrial septum. The patient was referred to early surgery for the resection of the mass. Histopathology and immunohistochemistry of the resected specimen demonstrated B cell non-Hodgkin lymphoma. Positron emission tomography and computerized tomography showed no lymph node and organ involvement. Two weeks after surgery, he was discharged and referred to the hematology department for chemotherapy. After 6 cycles, the positron emission tomography scan showed no abnormal accumulation indicating complete remission 7 months later. The clinical course of the patient was favorable for 1 and a half years.
Acute myocardial infarction may be a manifestation of a rare entity such as primary cardiac lymphoma and an embolic source should always be considered. This is a case of pathologically diagnosed and successfully treated primary cardiac lymphoma.
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