Relapsed chronic lymphocytic leukemia with a cardiac mass: A case report
Chronic lymphocytic leukemia (CLL) is the most common hematological malignancy in the USA. Extra-medullary disease is very rare and is not well characterized. In practice, clinically significant cardiac or pericardial involvement by CLL is extremely rare with only a few case reports in literature. W...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-05-01
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| Series: | Radiology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1930043323001589 |
| _version_ | 1827975250021711872 |
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| author | Amir A. Mahmoud, MD Ali Abdelhay, MD Mariam Mostafa, MD Mohamed Salah Mohamed, MD Zuhair Alam, MD Robin M. Reid, MD |
| author_facet | Amir A. Mahmoud, MD Ali Abdelhay, MD Mariam Mostafa, MD Mohamed Salah Mohamed, MD Zuhair Alam, MD Robin M. Reid, MD |
| author_sort | Amir A. Mahmoud, MD |
| collection | DOAJ |
| description | Chronic lymphocytic leukemia (CLL) is the most common hematological malignancy in the USA. Extra-medullary disease is very rare and is not well characterized. In practice, clinically significant cardiac or pericardial involvement by CLL is extremely rare with only a few case reports in literature. We report a 51-year-old male patient with a past medical history of CLL in remission, who presented with fatigue, dyspnea on exertion, night sweats and left supraclavicular lymphadenopathy. Laboratory investigations were notable for leukopenia and thrombocytopenia. Due to high suspicion of an underlying malignant process, a full body computerized tomography (CT) scan was obtained and showed an 8.8 cm soft tissue mass-like lesion occupying the majority of the right atrium and extending into the right ventricle, with probable pericardial involvement. Enlarged left supraclavicular and mediastinal lymph nodes were also present and had a mild mass effect on the traversing left internal thoracic artery and left pulmonary artery. A transesophageal echocardiogram and cardiac magnetic resonance imaging (MRI) were done to better characterize the cardiac mass. They confirmed a large infiltrating mass (measuring 10 × 7.4 cm) in the right atrium and ventricle, extending into the inferior vena cava inferiorly and coronary sinus posteriorly. A left supraclavicular excisional lymph node biopsy was performed and histopathology was consistent with Small Lymphocytic Lymphoma (SLL)/CLL. This case represents one of the few known cases of cardiac extramedullary-CLL presenting with an isolated cardiac mass. Further studies are needed to characterize the course of the disease, prognosis and optimum management along with the role of surgery. |
| first_indexed | 2024-04-09T20:08:35Z |
| format | Article |
| id | doaj.art-4816ab952e1a4a5096de24eb51fa9ee7 |
| institution | Directory Open Access Journal |
| issn | 1930-0433 |
| language | English |
| last_indexed | 2024-04-09T20:08:35Z |
| publishDate | 2023-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Radiology Case Reports |
| spelling | doaj.art-4816ab952e1a4a5096de24eb51fa9ee72023-04-01T08:46:42ZengElsevierRadiology Case Reports1930-04332023-05-0118519631967Relapsed chronic lymphocytic leukemia with a cardiac mass: A case reportAmir A. Mahmoud, MD0Ali Abdelhay, MD1Mariam Mostafa, MD2Mohamed Salah Mohamed, MD3Zuhair Alam, MD4Robin M. Reid, MD5Department of Medicine, Rochester General Hospital, 1425 Portland Ave, New York, NY 14621, USA; Corresponding author.Department of Medicine, Rochester General Hospital, 1425 Portland Ave, New York, NY 14621, USADepartment of Medicine, Rochester General Hospital, 1425 Portland Ave, New York, NY 14621, USADepartment of Medicine, Rochester General Hospital, 1425 Portland Ave, New York, NY 14621, USADepartment of Hematology and Medical Oncology, Rochester General Hospital, New York, NY, USADepartment of Hematology and Medical Oncology, Rochester General Hospital, New York, NY, USAChronic lymphocytic leukemia (CLL) is the most common hematological malignancy in the USA. Extra-medullary disease is very rare and is not well characterized. In practice, clinically significant cardiac or pericardial involvement by CLL is extremely rare with only a few case reports in literature. We report a 51-year-old male patient with a past medical history of CLL in remission, who presented with fatigue, dyspnea on exertion, night sweats and left supraclavicular lymphadenopathy. Laboratory investigations were notable for leukopenia and thrombocytopenia. Due to high suspicion of an underlying malignant process, a full body computerized tomography (CT) scan was obtained and showed an 8.8 cm soft tissue mass-like lesion occupying the majority of the right atrium and extending into the right ventricle, with probable pericardial involvement. Enlarged left supraclavicular and mediastinal lymph nodes were also present and had a mild mass effect on the traversing left internal thoracic artery and left pulmonary artery. A transesophageal echocardiogram and cardiac magnetic resonance imaging (MRI) were done to better characterize the cardiac mass. They confirmed a large infiltrating mass (measuring 10 × 7.4 cm) in the right atrium and ventricle, extending into the inferior vena cava inferiorly and coronary sinus posteriorly. A left supraclavicular excisional lymph node biopsy was performed and histopathology was consistent with Small Lymphocytic Lymphoma (SLL)/CLL. This case represents one of the few known cases of cardiac extramedullary-CLL presenting with an isolated cardiac mass. Further studies are needed to characterize the course of the disease, prognosis and optimum management along with the role of surgery.http://www.sciencedirect.com/science/article/pii/S1930043323001589CLLExtra-medullary CLLCardiac massCardiac tumorCase report |
| spellingShingle | Amir A. Mahmoud, MD Ali Abdelhay, MD Mariam Mostafa, MD Mohamed Salah Mohamed, MD Zuhair Alam, MD Robin M. Reid, MD Relapsed chronic lymphocytic leukemia with a cardiac mass: A case report Radiology Case Reports CLL Extra-medullary CLL Cardiac mass Cardiac tumor Case report |
| title | Relapsed chronic lymphocytic leukemia with a cardiac mass: A case report |
| title_full | Relapsed chronic lymphocytic leukemia with a cardiac mass: A case report |
| title_fullStr | Relapsed chronic lymphocytic leukemia with a cardiac mass: A case report |
| title_full_unstemmed | Relapsed chronic lymphocytic leukemia with a cardiac mass: A case report |
| title_short | Relapsed chronic lymphocytic leukemia with a cardiac mass: A case report |
| title_sort | relapsed chronic lymphocytic leukemia with a cardiac mass a case report |
| topic | CLL Extra-medullary CLL Cardiac mass Cardiac tumor Case report |
| url | http://www.sciencedirect.com/science/article/pii/S1930043323001589 |
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