Maude Pagé, MD, Agata E. Grasso, MD, John-Paul Carpenter, MD, Mary N

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Primary Cardiac Lymphoma: Diagnosis and the Impact of Chemotherapy on Cardiac Structure and Function Maude Pagé, MD, Agata E. Grasso, MD, John-Paul Carpenter, MD, Mary N. Sheppard, MD, Stefan P. Karwatowski, MD, Raad H. Mohiaddin, MD, PhD Canadian Journal of Cardiology Volume 32, Issue 7, Pages 931.e1-931.e3 (July 2016) DOI: 10.1016/j.cjca.2015.09.002 Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions

Figure 1 (A) Cardiac magnetic resonance images (using a Siemens Avanto 1.5T). Short-axis and 4-chamber views with different sequences. Steady-state free precession (SSFP) images show thickening and infiltration of the myocardium, predominantly affecting the right ventricular (RV) free wall and RV inferior wall. The infiltration crosses the atrioventricular grooves. Areas of high signal (white arrows) indicate active inflammation and edema within the infiltrated myocardium on a T2-weighted short tau inversion recovery sequence (T2W STIR). On T1-weighted spin echo (T1W), the masses are isointense with the underlying myocardium. There is marked late gadolinium enhancement (LGE) within the areas of infiltration (black arrows). (B, C) Histopathologic slides of myocardial biopsy tissue. (B) H and eosin–stained specimen showing atypical lymphoid cells (white arrow) infiltrating between the myocytes. (C) Immunohistochemical stain for CD-20 (specific B-cell marker) showing positively stained cells (black arrow). The insets show the slides at a higher magnification to illustrate the findings more clearly. Canadian Journal of Cardiology 2016 32, 931.e1-931.e3DOI: (10.1016/j.cjca.2015.09.002) Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions

Figure 2 Cardiac magnetic resonance images at baseline and 6 months after 6 cycles of chemotherapy. Complete resolution of the myocardial infiltration was observed, but there was residual right ventricular dilatation and what most likely represents extensive fibrosis in the free wall and inferior wall, seen as bright white on the LGE images (arrow). 4Ch, 4 chamber; LGE, late gadolinium enhancement; R-CHOP, rituximab, cyclophosphamide, doxorubicin (hydroxydaunorubicin), vincristine (Oncovin), and prednisone; SAX, short axis; SSFP, steady-state free precession. Canadian Journal of Cardiology 2016 32, 931.e1-931.e3DOI: (10.1016/j.cjca.2015.09.002) Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions