Diagnosis of Primary Cardiac T-cell Lymphoma: Feasibility and Safety of Endomyocardial Biopsy Guided by Pre-acquired Cardiovascular Magnetic Resonance

  • Andrea Avella Cardiology Division and Cardiac Arrhythmia Unit, St. Camillo-Forlanini Hospital, Rome, Italy
  • Carla Giordano Department of Radiology, Oncology and Pathology, Sapienza University, Rome, Italy
  • Vitaliano Buffa Cardiovascular Imaging Unit, St. Camillo-Forlanini Hospital, Rome, Italy
  • Piergiuseppe De Girolamo Cardiology Division and Cardiac Arrhythmia Unit, St. Camillo-Forlanini Hospital, Rome, Italy
  • Massimo Uguccioni Cardiology Division and Cardiac Arrhythmia Unit, St. Camillo-Forlanini Hospital, Rome, Italy

Keywords

Cardiac tumour, cardiac magnetic resonance, right-sided catheterization, endomyocardial biopsy

Abstract

Background: Multimodality imaging of a cardiac mass lesion may raise suspicion of a primitive cardiac lymphoma (PCL). However, a definitive diagnosis requires histopathological confirmation.

Methods: This report describes the methodology we used to perform biopsy sampling of a cardiac mass lesion affecting a 45-year-old man. In order to increase endomyocardial biopsy diagnostic accuracy, we used pre-acquired cardiac magnetic resonance (CMR) images to guide the bioptome on a cardiac site overtly infiltrated by the suspected tumour. The right ventricular outflow tract was identified as the target site for biopsy sampling. To reduce the risk of the procedure, the biopsy was performed at a safe distance from the tip of a diagnostic quadripolar catheter positioned at the level of the pulmonary valve, previously identified by pacing manoeuvres. The reported approach demonstrated safety and diagnostic accuracy, allowing the identification of an extremely rare PCL subtype of T-cell origin.

Conclusion: Biopsy sampling of a suspected tumour may be safely and accurately performed using pre-acquired CMR images to guide the bioptome on the target site.

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References

  • Petrich A, Cho SI, Billett H. Primary cardiac lymphoma: an analysis of presentation, treatment and outcome patterns. Cancer 2011;117:581–589.
  • Carras S, Berger F, Chalabreysse L, Callet-Bauchut E, Cordier J-F, Salles G, et al. Primary cardiac lymphoma: diagnosis, treatment and outcome in a modern series. Hematol Oncol 2017;35(4):510–519.
  • Werner D, Schmeisser A, Daniel WG. Images in cardiology: primary cardiac lymphoblastic T cell lymphoma. Heart 2001;86(6):618.
  • Patel J, Melly L, Sheppard MN. Primary cardiac lymphoma: B- and T-cell cases at a specialist UK centre. Ann Oncol 2010;21(5):1041–1045.
  • Li B, Li R, Wu B, Chen X, Ni Y, Li W. Primary cardiac T cell lymphoma. J Card Surg 2012;27:457–460.
  • Pirzada A, Connors S, Harris S, Adams C. Primary cardiac T cell lymphoma mimicking ST-elevation myocardial infarction. Cardiology 2017;138:259–263.
  • Jovanicius K, Salcius K, Meskauskas R, Valeviciene N, Tarutis V, Sirvydis V. Primary cardiac lymphoma: two cases and a review of literature. J Cardiothorac Surg 2015;10:138.
  • Bhattacharyya S, Khattar RS, Gujral DM, Senior R. Cardiac tumors: the role of cardiovascular imaging. Expert Rev Cardiovasc Ther 2014;12(1):37–43.
  • Burling F, Devlin G, Heald S. Primary cardiac lymphoma diagnosed with transesophageal echocardiography-guided endomyocardial biopsy. Circulation 2000;101(17):E179–E181.
  • Zanobini M, Dello Russo A, Saccocci M, Conti S, De Camilli E, Vettor G, et al. Endomyocardial biopsy guided by intracardiac echocardiography as a key step in intracardiac mass diagnosis. BMC Cardiovasc Disord 2018;18(1):15.
  • Published: 2021-03-25

    Issue: Vol 8 No 3 (view)

    Section: Articles

    How to cite:
    1.
    Avella A, Giordano C, Buffa V, De Girolamo P, Uguccioni M. Diagnosis of Primary Cardiac T-cell Lymphoma: Feasibility and Safety of Endomyocardial Biopsy Guided by Pre-acquired Cardiovascular Magnetic Resonance. EJCRIM 2021;8 doi:10.12890/2021_002427.