ABSTRACT

To raise awareness for differential diagnosis of fibrin-associated diffuse large B-cell lymphoma with patients that have sustained chronic inflammation or are immunocompetent with a previous Epstein-Barr virus infection.

A 58-year-old male patient was admitted to the Clinical Center of Sarajevo University, Cardiovascular Surgery Department with the symptoms of getting tired quickly accompanied by dyspnea. His echocardiography findings exhibited a large polymorphic clavicle type highly mobile formation in his left atrium with a size of 76x23mm, intermittently prolapsing the annulus of the mitral valve and reaching the middle of the extended left ventricle. After the detection of a cardiac mass, the patient underwent surgery and had a total excision of the mass. Histopathological analysis showed a tumor made of stellate cells that form complex structures resembling wires together with an islet of plasma cells embedded in a myxoid/fibrinoid background. Immunohistochemically, lymphoma cells were positively stained for CD20, CD30, MUM1, and EBER. After excluding all other systemic manifestations of any other diseases, the patient was diagnosed with fibrin-associated diffuse large B-cell lymphoma, as a primary cardiac lymphoma, and myxoma.

In conclusion, we are reporting a very rare case seen approximately 3% of all lymphomas in the Western Population associated with Epstein-Barr virus B-cell Lymphoproliferative disorders, therefore making them harder to diagnose due to limited experience. Albeit being an infrequent disease fibrin-associated diffuse large B-cell lymphoma should be an entity included in the differential diagnosis of the patients that have sustained chronic inflammation or are immunocompetent with a previous Epstein-Barr virus infection.

Keywords: Cardiac myxoma, diffuse large B-cell lymphoma, Epstein-Barr virus infection