PB1833 PRIMARY CARDIAC LYMPHOMA

Background: Primary cardiac lymphomas (PCL) are rare, with a fatal course unless diagnosed and treated in time. Non‐neoplastic causes such as infections and thrombi account for most cardiac masses. The most common cardiac tumors are benign, such as myxomas, being sarcomas the most frequent malignancy. Symptoms are inespecific, PCL can present as heart failure, arrythmias, vena cava thrombosis, thromboembolic disease. Patients must examined thoroughly, including echocardiography, CT or MRI and bone marrow biopsy. Final diagnosis will require a biopsy of the cardiac mass. Treatment is with chemotherapies according to lymphoma subtype, usually anthracycline based regimens. If ventricular outflow tract is compromised surgery may be needed due to hemodynamic instability which is associated with a very bad prognosis Aims: To describe a case of a patient with PCL Methods: A case report Results: Case: a 59 years old woman consulted for bilateral lower extremities edema and abdominal distension. She had a previous history of HIV infection diagnosed 10 years ago treated with nevirapine, lamivudine and zidovudine. Last CD4 count was 283/mm3 and viral load undetectable. Laboratory: Hg 13,5 g/dl, WBC 9400/mm3 (Neutrophil 80%, no atypical cells or blast in blood smear), platelet 344000/mm3, coagulation test, protein electrophoresis, hepatic and renal function were normal, D‐dimer 6 mg/l (normal< 0,5), Hepatitis C and B test were negative, LDH 1200U/l(100‐210) Abdominal ultrasound showed ascites, liver and spleen were normal. Serum‐Ascites albumin gradient was > 1,1 g/dl (suggestive of transudate). AngioCT: ascites, thrombosis of iliac, right renal and inferior cava vein (IVC) thrombosis, cardiac mass in both auricles and right ventricle extending to IVC, signs of segmentary pulmonary embolism (PE). Echocardiogram: atrial mass invading interauricular septum and occupying almost 50% of atrial surface. Anticoagulation with enoxaparin 1 mg/kg BID was initiated and an angiography guided biopsy was done. Preliminary results were compatible with lymphoma so we added metilprednisolone 500 mg/day for 3 days with no clinical improvement. Chemotherapy was initiated with CHOP + methotrexate. Bone marrow biopsy showed no lymphoma infiltration and pathology results of the cardiac mass were compatible with pax5, CD10 and TDT positive b cell lymphoblastic lymphoma. On day 9, despite clinical improvement, she presented cardiac arrest and died. An echocardiogram done than day showed a 50% reduction in the mass size and fragmentation of it. An angio CT was done to rule out PE but was negative. Summary/Conclusion: PCL diagnoses is challenging and may have a dismal clinical course. A prompt diagnostic is necessary as soon as possible. We present this case due to the rarity of a solitary cardiac mass as the presentation of lymphoblastic lymphomas.