Introduction: Diffuse large B cell lymphoma (DLBCL) is an aggressive and fast-growing type of lymphoma. Cardiac lymphoma is a rare cardiac tumor and an even more rare extranodal site of lymphoma, of which the most common type is DLBCL. (1-3) We report a case of an 85-year-old female patient with pericardial lymphoma presenting with persistent effusions.

Case report: 85-year-old female patient presented with sudden onset chest pain and dyspnea. A week before she was diagnosed with atrial fibrillation and warfarin and bisoprolol therapy was started. Echocardiography showed a circular pericardial effusion up to 20 mm thickness with no signs of impending tamponade. Thoracic, abdominal and pelvic CT showed no pathology, apart from the effusion. Laboratory tests showed a suspected M-protein and IgM/kappa through serum protein electrophoresis. A 3-week follow-up revealed a progression in effusion volume (29 mm) and symptoms exacerbation with ankle edema, chest pain and night sweats. Cytological analysis of an effusion sample verified DLBCL with plasma cell differentiation. The same was confirmed by bone marrow biopsy. Imaging showed no signs of lymphadenopathy or hepatosplenomegaly. Lymphoma was staged as Ann Arbour IVB and IRI 3. Therapy was initiated according to the R-CEOP protocol. After 4 therapy cycles echocardiography showed no signs of effusion. A total of 8 therapy cycles were administered and a control work-up showed total remission of the disease.

Conclusion: New therapeutic protocols for this type of aggressive lymphoma have significantly improved patient survival rates. Clinical presentation is usually unspecific with a wide differential diagnosis. Given that extranodal and cardiac involvement is a negative prognostic sign for patient survival, efforts are warranted to improve the time to diagnosis and therapy initiation necessary for a favorable outcome.