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病例报告:新诊断的原发性心脏B细胞淋巴瘤中完全性房室传导阻滞成功逆转

Case report: Complete atrio-ventricular block successfully reversed in newly diagnosed primary cardiac B-cell lymphoma.

作者信息

Mao Jiahui, Xu Yitong, Zhu Mingfang, Wang Luqun, Hou Yu

机构信息

Department of Hematology, Qilu Hospital of Shandong University, Jinan, China.

Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital of Shandong University, Jinan, China.

出版信息

Front Med (Lausanne). 2023 Mar 15;10:1119286. doi: 10.3389/fmed.2023.1119286. eCollection 2023.

Abstract

Primary cardiac tumors are extremely uncommon and primary cardiac lymphoma (PCL) is an even rarer subset. A definite diagnosis can be delayed, which increases the likelihood of a poor prognosis. We report a case involving a 64-year-old male who presented with dyspnea, palpitation, and third-degree atrioventricular block (AVB) secondary to primary cardiac B-cell lymphoma that was diagnosed endomyocardial biopsy (EMB) and multimodality imaging. Chemotherapy was initiated using rituximab, cyclophosphamide, vindesine, and prednisone (R-COP) followed by implantation of an artificial capsule pacemaker. Third-degree AVB vanished, and the subsequent cycle of treatment was adjusted as R-CDOP (rituximab, cyclophosphamide, doxorubicin liposome, vindesine, and prednisone), with aspirin and rosavastatin to prevent ischemic events. So far, the patient had a good clinical course and normal electrocardiogram. This case underscores the importance of EMB in the diagnosis of heart neoplasms. It is worth noting that anthracycline is not contraindicated in PCL.

摘要

原发性心脏肿瘤极为罕见,原发性心脏淋巴瘤(PCL)更是其中极为罕见的一种亚型。明确诊断可能会延迟,这增加了预后不良的可能性。我们报告一例64岁男性病例,该患者因原发性心脏B细胞淋巴瘤出现呼吸困难、心悸和三度房室传导阻滞(AVB),通过心内膜心肌活检(EMB)和多模态成像得以确诊。开始使用利妥昔单抗、环磷酰胺、长春地辛和泼尼松(R-COP)进行化疗,随后植入人工胶囊起搏器。三度AVB消失,后续治疗方案调整为R-CDOP(利妥昔单抗、环磷酰胺、阿霉素脂质体、长春地辛和泼尼松),并使用阿司匹林和瑞舒伐他汀预防缺血事件。到目前为止,该患者临床病程良好,心电图正常。该病例强调了EMB在心脏肿瘤诊断中的重要性。值得注意的是,蒽环类药物在PCL中并非禁忌。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5f74/10050578/357caadb013e/fmed-10-1119286-g001.jpg

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