A 74-year-old man was evaluated for iron deficiency anemia. The gastrointestinal (GI) work-up showed Schatzki's ring, gastritis, and two adenomatous polyps. Oral iron therapy was initiated, and the anemia improved.
Six months later, the patient presented with dyspnea and edema of the lower extremities. Drs Ramesh Adabala, Stephen A. Volk, and Subhash C. Proothi of Bethlehem, Pa, ordered two-dimensional echocardiography, which revealed a large mass in the right side of the heart and a pericardial effusion. A pericardial window was created, and it drained 400 mL of serous fluid. CT of the chest disclosed a 5-cm mass within the right side of the heart, centered in the region of the tricuspid valve and extending into the right atrium and ventricle (A). Cardiac catheterization was performed, and a biopsy of the mass revealed diffuse large B-cell lymphoma.
Surface markers were positive for clusters of differentiation CD20 and CD79. Additional CT scans and a bone marrow biopsy showed no evidence of tumor elsewhere in the body. Thus, the diagnosis was primary cardiac B-cell lymphoma unrelated to the previously diagnosed anemia.
The patient is undergoing treatment with cyclophosphamide, hydroxydaunomycin, vincristine, and prednisone (CHOP). After 3 months of CHOP chemotherapy, the tumor apparently is regressing (B).