A Malignant Squeeze: A Rare Cause of Cardiac Tamponade

Primary cardiac lymphoma (PCL) is a rare condition described as a lymphoma localized to the heart or pericardium. Althoughcardiac involvement is seen in 10–20% of non-Hodgkin’s lymphomas, PCL is extremely rare. It comprises merely 0.5% of alllymphomas and 1.3–2% of cardiac malignancies. Early detection is essential to avoid potentially fatal complications, andprognosis is highly dependent on the management of cardiac complications. The etiology of PCL is still unknown, andmolecular characterization has yet to be studied leaving a great deal of research to be done in order to gain a betterunderstanding of this rare disease process. We discuss the case of an 85-year-old female presenting with dyspnea and chest pain.Computed tomography of the chest revealed a pericardial effusion, and subsequent echocardiogram demonstrated a largecircumferential effusion. She underwent emergent pericardiocentesis. Morphologic and immunophenotypic features wereconsistent with high-grade B-cell lymphoma witht8;14, and the patient was started on rituximab, cyclophosphamide,doxorubicin, vincristine, and prednisone (R-CHOP) with excellent response.