Secondary Giant Cardiac Lymphoma Treated by Stepwise Chemotherapy With Multimodal Imaging

Figures

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  Visual Summary. Serial Multimodal Imaging During Chemotherapy Red dotted circle indicates a suspected thrombotic component. CPA = cyclophosphamide; Pola-R-CHP = polatuzumab, rituximab, cyclophosphamide, doxorubicin, and prednisolone; PSL = prednisolone.

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  Figure 1. 12-Lead Electrocardiography and Chest Radiography (A) 12-lead electrocardiography demonstrating sinus rhythm with a heart rate of 93 beats/min. (B) Chest radiography showing cardiomegaly with a cardiothoracic ratio of 64%.

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  Figure 2. Transthoracic Echocardiography and Computed Tomography Images at Admission (A) A large mass extending through the right atrium and right ventricle (yellow arrow), with partial mobility. (B) Contrast-enhanced computed tomography demonstrating a mass comparable in size to that observed on transthoracic echocardiography, with a suspected thrombotic component (red circle).

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  Figure 3. Parasternal Short-Axis View on Transthoracic Echocardiography Parasternal short-axis view showing that the right coronary artery is running through the mass (yellow arrow).

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  Figure 4. Histopathological and Immunohistochemical Findings HE staining showing diffuse proliferation of large atypical lymphoid cells (A: original magnification ×100; B: original magnification ×400). Immunohistochemical findings revealed tumor cells positive for CD20 (C: original magnification ×400), CD10 (D: original magnification ×400), and BCL6 (E: original magnification ×400) and negative for CD3 (F: original magnification ×400) expression. BCL = B-cell lymphoma; CD = cluster of differentiation; HE = hematoxylin and eosin.

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  Figure 5. Images of Echocardiography and Computed Tomography After 1 Week of Cyclophosphamide Monotherapy (A) Transthoracic echocardiography and (B) computed tomography images after 1 week of cyclophosphamide monotherapy.

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  Figure 6. Images of Echocardiography and Computed Tomography After 1 Week of Cyclophosphamide and Prednisolone Therapy (A) Transthoracic echocardiography and (B) computed tomography images after 1 week of cyclophosphamide and prednisolone therapy.

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  Figure 7. Images of Echocardiography and Computed Tomography After 1 Cycle of Pola-R-CHP Therapy (A) Transthoracic echocardiography and (B) computed tomography images after 1 cycle of polatuzumab, rituximab, cyclophosphamide, doxorubicin, and prednisolone therapy.

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  Figure 8. Images of Echocardiography and Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography After 6 Cycles of Pola-R-CHP Therapy Transthoracic echocardiography and fluorine-18 fluorodeoxyglucose positron emission tomography–computed tomography after 6 cycles of polatuzumab, rituximab, cyclophosphamide, doxorubicin, and prednisolone therapy. (A) Transthoracic echocardiography showing almost complete disappearance of the cardiac mass. (B) Fluorine-18 fluorodeoxyglucose positron emission tomography–computed tomography showing slight residual uptake near the tricuspid annulus whereas the mass is almost completely resolved.