Primary Cardiac Lymphoma in an Immunocompetent 71-Year-Old Man

Isolated cardiac lymphomas are very rare, especially in immunocompetent patients. As a consequence, little is known about the best therapeutic management and about patients'' outcomes in these cases. Diffuse large B-cell lymphoma is the most frequent subtype; anthracycline-based chemotherapy has been the most successful treatment. We describe the case of a primary cardiac lymphoma in an immunocompetent 71-year-old man. As of December 2015, the patient had been in clinical remission for 2 years. The most relevant literature on primary cardiac lymphoma is reported and discussed.     

Primary Cardiac Pleomorphic Sarcoma Presenting as Back Pain in an 18-Year-Old Man

Soft-tissue sarcoma is the most prevalent primary malignant cardiac tumor. This sarcoma usually presents with cardiac manifestations secondary to local obstruction or arrhythmias; very rarely does it present with initial symptoms of distant metastasis. We discuss the unusual case of an 18-year-old man who emergently presented with acute-on-chronic back pain. Imaging revealed a lesion on the 12th thoracic vertebra and a large mass arising from the left atrium. The cardiac mass was resected, and immunohistochemical analysis revealed it to be a pleomorphic sarcoma that had metastasized to the spine. The patient died 2 years later of diffuse metastases. In addition to the patient''s case, we discuss the nature and treatment of cardiac sarcoma.Key words: Bone neoplasms/secondary, heart neoplasms/diagnosis/pathology/surgery, sarcoma/complications/diagnosis/surgeryPrimary cardiac tumors are rare and usually benign. Approximately 15% to 20% of cardiac neoplasms are malignant.^1,2 Chief among these is soft-tissue sarcoma, the second-most prevalent of all primary cardiac tumors.^3,4 The typical presentation of cardiac sarcoma results from an anatomic obstruction of blood flow. Initial presentation in the form of occult distant metastasis is highly unusual, and only sporadic cases have been described.⁵ We report the case of a young man in whom a metastatic cardiac sarcoma presented as back pain, and we discuss the nature and treatment of these neoplasms.     

Intrapericardial Primary Thymic Carcinoma in a 73-Year-Old Man

Thymic carcinoma is a rare, highly aggressive type of tumor that typically occurs in the anterior mediastinum. We describe the case of a 73-year-old man who presented with weakness, cough, dyspnea, anorexia, and weight loss. An echocardiogram showed an intrapericardial mass that occupied the space around the lateral walls of the left ventricle and distally compressed the right ventricle. Magnetic resonance imaging and a biopsy confirmed the presence of intrapericardial primary thymic carcinoma. The patient underwent surgical excision of the tumor and died of right ventricular rupture during the procedure. This case highlights the importance of considering thymic carcinoma whenever an otherwise unexplained intrapericardial mass is encountered.Key words: Intrapericardial tumors, pericardium/pathology, thymus neoplasms/pathology, thymic carcinoma/diagnosis/echocardiography/magnetic resonance imaging/surgeryThymic carcinoma is a rare, aggressive, epithelial malignant tumor that usually occurs in the anterior mediastinum. The typical patient is a 30- to 50-year-old man. Thymic carcinomas that involve the heart tend to be metastasized mediastinal tumors and seldom originate intrapericardially. It is possible that during the embryologic stage some thymic tissue is left behind in the pericardium as the thymus develops. Such tissue may turn into an intrapericardial tumor.¹ Only a few primary intrapericardial thymic carcinomas have been reported in the medical literature.^2–6 We recently encountered such a lesion in an elderly patient.     

Coronary Artery Stenosis Caused by Primary Malignant Pericardial Mesothelioma in a 76-Year-Old Man

This report describes a 76-year-old man with diabetes mellitus who developed coronary artery stenosis from infiltration of a primary malignant pericardial mesothelioma. Three months before referral to the treating hospital, elevated liver function values and cardiac enzymes led to echocardiography, which revealed a motion abnormality in the anterior wall of the heart. The patient was diagnosed with congestive heart failure and admitted to the hospital, where chest computed tomography showed a tumor above the left atrial appendage that compressed the origin of the left anterior descending artery. He was referred to the treating hospital for surgery. Minimally invasive direct coronary artery bypass grafting was performed, but the mass was not resected because of its infiltrating nature and the potential for medical complications. Histologic examination of a biopsy specimen confirmed a primary malignant pericardial mesothelioma. The bypass procedure resolved the coronary artery stenosis caused by the tumor. Although the optimal treatment for primary malignant pericardial mesothelioma is controversial, minimally invasive methods, such as minimally invasive direct coronary artery bypass grafting, may be used successfully.     

Ochronotic Involvement of the Aortic and Mitral Valves in a 72-Year-Old Man

Ochronosis, an autosomal recessive metabolic disorder, causes an excess of homogentisic acid that results in adverse pigmentation, calcification, and inflammation of cartilaginous and other tissues. Cardiovascular abnormalities are less frequently reported than are other manifestations. In rare cases, ochronosis can cause valvular heart disease. We report the case of a 72-year-old man with aortic stenosis and mitral insufficiency who was diagnosed with ochronosis while undergoing surgical aortic and mitral valve replacement. We discuss the history and surgical management of alkaptonuric ochronosis.