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*To whom correspondence should be addressed: Dr. Rabiya Jalil Clinical Assistant Professor, Regina Qu’Appelle Health Region Regina, SK, S4P 0W5, Canada Email: habib31@sasktel.net CASE STudy A previously healthy 55-year old Caucasian male presented with a two month history of flu-like symptoms, dry cough, and progressive shortness of breath. He also presented with a one and a half month history of a slowly growing painless swelling on the left side of his neck. Examination revealed normal vital signs, an erythematous, firm but mobile mass on the left side of the neck, and signs of a right sided pleural effusion. Transesophageal echocardiography (TEE) showed a 4.5 X 3 cm echodensity in the right ventricle. Furthermore, a 3.5 X 3.5 cm sessile echodensity was noted in the right atrium. The left and right ventricles were normal in size and function with an ejection fraction of 60%. There was trace circumferential pericardial effusion. CT scanning of the neck displayed a fungating and ulcerating soft tissue mass situated at the dermal layer measuring 3.5 X 1.7 cm and located above the level of the hyoid at the lower end of the left parotid gland. CT of the chest revealed an extensive bulky filling defect in the right atrium, right ventricle, and outflow track at the level of the pulmonary valve. Multiple low density lesions were evident in the right lobe of the liver (Figure 1). Lymphadenopathy was noted inferior to the aortic bifurcation. In addition, biopsy of the neck mass revealed a lymphoid infiltrate with atypical features. A majority of cells were positive for CD20, CD10, CD79a, and TdT, but negative for CD34, and BCL-2 on immunohistochemical staining. Proliferation rate approached 100% for Ki-67. The morphology was consistent with a high grade B-cell lymphoma with atypical Burkitt/Burkitt-like features.

A Man with a Neck Mass, Pleural Effusion and Hypoechoic Masses in the Right Atrium and Ventricle