# Case Report: Primary cardiac diffuse large B-cell lymphoma with sick sinus syndrome and literature review on disease management and therapeutic strategies

## TL;DR

This case report details a rare heart lymphoma case and its treatment challenges, emphasizing the importance of timely diagnosis and management.

## Contribution

The paper presents a rare clinical case and a literature review on therapeutic strategies for primary cardiac DLBCL.

## Key findings

- A 73-year-old male with primary cardiac DLBCL achieved remission through multiple chemotherapy regimens.
- Treatment-related complications necessitated regimen changes, highlighting the need for adaptive strategies.
- New drugs have improved prognosis, but cardiotoxicities remain a concern for clinicians.

## Abstract

Primary cardiac diffuse large B-cell lymphoma (DLBCL) is a rare but clinically challenging extranodal lymphoma. Diagnosis and management are often complicated due to its nonspecific symptoms and rarity.

We reported a case of a 73-year-old male who initially presented with chest pain, high fever, dizziness, and amaurosis. Preliminary diagnostic assessments suggested sick sinus syndrome, necessitating the implantation of a dual-chamber pacemaker, and revealed a large mass in the interatrial septum. An endomyocardial biopsy confirmed the diagnosis of primary cardiac DLBCL. Initial treatment with R-miniCHOP chemotherapy yielded a partial response. However, due to treatment-related complications (grade 4 neutropenia and pneumonia), a change in the therapeutic regimen to OR-GemOx chemotherapy was made, leading to complete remission. A year later, the patient experienced a relapse, requiring a salvage treatment of the Pola-BR chemotherapy regimen, which again resulted in complete remission. Additionally, this review examines an in-depth literature review on the management and therapeutic strategies for this entity, focusing on the treatment recommendations for relapse/refractory disease.

Prompt diagnosis and effective management are crucial in treating primary cardiac DLBCL. While the emergence of new drugs has improved the prognosis by offering higher efficacy and fewer side effects, clinicians should be vigilant about potential cardiotoxicities.