Hodgkin’s Lymphoma Transformation into Diffuse Large B Cell Lymphoma Presented as a Right Atrial Mass: A Case Report

Akram Sardari; Mehrdad Salehi; Faeze Salahshour; Ali Mehrakizadeh; Babak Sattartabar

doi:10.18502/crcp.v8i5.15254

Akram Sardari Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Mehrdad Salehi Department of Cardiovascular Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Faeze Salahshour Department of Radiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Ali Mehrakizadeh Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Babak Sattartabar Trainee of Cardiology Residency, Department of Cardiology, Tehran Heart Center Hospital, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/crcp.v8i5.15254

Keywords: Hodgkin’s lymphoma; large B cell lymphoma; Transformation; Right atrial mass

Abstract

Cardiac involvement can occur in lymphoma, with the right heart being predominantly
affected. The prognosis for patients with cardiac involvement is poor. A 28-year-old man,
with a 4-year history of Hodgkin’s lymphoma, presented with progressive shortness
of breath and ascites. Chest X-ray (CXR) and CT scan revealed multiple masses in the
mediastinum. To exclude a pulmonary embolism, the patient underwent CT angiography,
which incidentally revealed a filling defect in the right atrium. Trans-esophageal
echocardiography confirmed the presence of a mass in the right atrium. Surgery was
performed to obtain samples of the mediastinal masses and the right atrium mass.
Pathological results indicated that the nature of the right atrium mass was diffuse large
B-cell lymphoma (DLBCL), suggesting that the Hodgkin’s lymphoma had transformed
into DLBCL. The transformation of Hodgkin’s lymphoma to DLBCL can occur, and cardiac
involvement is not common. Given that the transformation of Hodgkin’s lymphoma into
DLBCL can occur many years after the initial diagnosis, the authors recommend followup of these patients, as the prognosis may be worse than for non-transformed subtypes.