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\begin{document}

\title{Cardiac Involvement of Diffuse Large B-Cell Lymphoma Presenting as
Various Arrythmias}



\author[1]{Tadakiyo Ido}%
\author[1]{Hitoshi Minamiguchi}%
\author[1]{Yasuhiro Ichibori}%
\author[1]{Takaharu Hayashi}%
\author[1]{Nobuhiko Makino}%
\author[1]{Atsushi Hirayama}%
\author[1]{Yoshiharu Higuchi}%
\affil[1]{Osaka Police Hospital}%


\vspace{-1em}



  
  \date{May 17, 2024}


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\begin{abstract}
Symptomatic cardiac involvement of malignant lymphoma is rare. Silent
invasion of malignant lymphoma makes it difficult to diagnose it in the
early phase of clinical course. We describe a case with cardiac
involvement of diffuse large B-cell lymphoma presenting various types of
arrythmias that were not diagnosed until autopsy.%
\end{abstract}%



\sloppy


\textbf{Cardiac Involvement of Diffuse Large B-Cell Lymphoma Presenting
as Various Arrythmias}

Tadakiyo Ido, Hitoshi Minamiguchi, Yasuharu Ichibori, Takaharu Hayashi,
Nobuhiko Makino, Atsushi Hirayama, Yoshiharu Higuchi

Department of Cardiology, Osaka Police Hospital, Osaka, Japan

\textbf{Short title:} \begin{CJK}{UTF8}{gbsn}　\end{CJK}\selectlanguage{english}\textbf{Diffuse Large B-Cell Lymphoma and
Arrhythmia}

\textbf{Corresponding author:}

Hitoshi Minamiguchi, MD

Department of Cardiology, Osaka Police Hospital, Osaka, Japan

Postal address: 10-31, Kitayama, Tennoji, Osaka, Japan, zip code
543-0035

Email: \emph{hminmiguchi@gmail.com}

Tel: +81-6-6771-6051 Fax: +81-6-6775-2838

\textbf{Word count:} 198 words

\textbf{Financial disclosure:} none

\textbf{Key Words:} Sick sinus syndrome, Cardiac involvement, Malignant
lymphoma, Diffuse large B-cell lymphoma, Autopsy

\textbf{Abstract}

Symptomatic cardiac involvement of malignant lymphoma is rare. Silent
invasion of malignant lymphoma makes it difficult to diagnose it in the
early phase of clinical course. We describe a case with cardiac
involvement of diffuse large B-cell lymphoma presenting various types of
arrythmias that were not diagnosed until autopsy.

\textbf{CASE Images}

An 84-year-old male with an unknown fever and vomiting presented to our
institution. His electrocardiogram demonstrated sinus pauses up to 10
seconds. We thought the sinus arrest was caused by hyperkalemia
(potassium of 6.9 mEq/L) followed by worsening renal function (blood
urea nitrogen 84.6 mg/dL and creatinine 4.77 mg/dL). We immediately
placed a temporary pacemaker and performed continuous hemodiafiltration,
however, regardless of multidisciplinary treatment, he died on the
thirty-eighth day of admission. His autopsy revealed cardiac involvement
of diffuse large B-cell lymphoma (DLBCL). The diffuse infiltrated large
lymphoid cells were observed to have right atrial dominance (Figure A).
In this clinical course, the electrocardiogram demonstrated atrial
tachycardia with 3:1 conduction and atrial fibrillation (Figure B). Both
tachycardias were followed by sinus arrest. The patient presented with
various types of arrhythmias such as sick sinus syndrome, atrial
tachycardia, and atrial fibrillation. Theoretically, the infiltrated
DLBCL invaded the sinus node and right atrium, then induced these
various arrhythmias in this case. Alternatively, cardiac involvement of
malignant lymphoma is usually non-symptomatic\textsuperscript{1}. It is
important not to dismiss a rare symptomatic case of cardiac involvement
of malignant lymphoma since there were various types of arrhythmias that
might have been treated with chemotherapy\textsuperscript{2}.

\textbf{AUTHOR CONTRIBUTIONS}

TI and HM contributed to treat the patient and drafted the manuscript,
YI, TH and NM contributed to diagnose and treat the patient, and AH and
YH critically reviewed the literature and involved in writing. All
authors approved the final manuscript.

\textbf{ACKNOWLEDGMENTS}

None

\textbf{CONFLICT OF INTEREST}

None declared.

\textbf{DATA AVAILABILITY STATEMENT}

The data that support the findings of this study are available from the
corresponding author upon reasonable request.

\textbf{CONSENT}

Written informed consent was obtained from the patient to publish this
report in accordance with the journal's patient consent policy.

\textbf{Figure legend}

A-a) The widespread malignant tumor appeared as a light-yellow color.
A-b, c) Histology showing that the malignant tumor cells had invaded a
large amount of the right atrium (hematoxylin-eosin stain, magnification
x40, x100).

B-a) Atrial tachycardia with 3:1 conduction. B-b) Atrial fibrillation.

\textbf{REFERENCES}

1. W.C. Roberts, D.L. Glancy, V.T. Devita. Heart in malignant lymphoma
(Hodgkin's disease, lymphosarcoma, reticulum cell sarcoma and mycosis
fungoides). Am. J. Cardiol. 1968;22:85--107. 2. M. Haq, A. Patel, M.
Guglin. Cardiac lymphoma: Sinus pauses disappear after chemotherapy.
Ann. Hematol. 2014;93:891--892.\selectlanguage{english}
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