Cardiac Lymphoma Presenting as Superior Vena Cava Syndrome Mimicking Venous Thrombosis

Figures

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  Figure 1. Doppler study of neck veins. Doppler study of the neck vein showed a dilated internal jugular vein with streamlined flow, indicating distal obstruction (A). An end-on view of IJV showed thrombus within its lumen (B). IJV: internal jugular vein

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  Figure 2. Transthoracic echocardiography (apical four-chamber view) with color Doppler study. A transthoracic echocardiography (apical four-chamber view) with color Doppler revealed a dilated right atrium with a homogeneous mass measuring 4.6x3.7 cm extending into the coronary sinus, no gradient across the tricuspid valve, trivial tricuspid regurgitation, a small inter-atrial septal defect with continuous flow across the septum, and a thin rim of pericardial effusion.

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  Figure 3. CT chest and MRI heart. Chest CT demonstrated a homogeneous non-contrast-enhancing mass involving the entire chamber of the right atrium (red circle), extending into the lumen of the superior vena cava (white arrows above) and projecting into the left atrium through the small atrial septal defect (lower white arrow), with dilation of the right atrium (A, B). Cardiac MRI showed a homogeneous mass involving the entire chamber of the right atrium (red circle), extending into the lumen of the superior vena cava (white arrows above) and projecting into the left atrium through the small atrial septal defect (lower white arrow), with dilation of the right atrium (C).

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  Figure 4. Intraoperative photographs showing a right atrial mass and its extent (A, B, and C). Intraoperative images showing an intracardiac tumor seen in the right atrium with extension into the superior vena cava and innominate vein, with superior vena cava obstruction and infiltration into the right atrial wall, right atrioventricular groove, and the space between the aorta and superior vena cava.

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  Figure 5. Biopsy specimen low power and high power view. A low-power view of the biopsy specimen showed sheets of atypical lymphoid cells distributed in the cardiac tissue (A). A high-power view of the biopsy specimen showed pleomorphic cells with scant cytoplasm, a high nuclear-to-cytoplasmic ratio, hyperchromatic nuclei with indistinct nucleoli, and visible mitotic figures (B).

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  Figure 6. Immunohistochemistry confirming the diagnosis of large B-cell lymphoma. Neoplastic cells were negative for CD3 (A), with diffuse strong membranous positivity for CD20 (B) and CD30 positivity (C), confirming the diagnosis of large B-cell lymphoma.