The Drowning Heart: An Ambiguous Lymphoma

Miller et al report a case of a 57-year-old woman who had been healthy and running several miles a day, was transferred from an outside hospital for further evaluation of pericardial effusion. She had no medical history, took only a daily multivitamin, and had a distant history of tobacco use. The diagnosis of cardiac tamponade is a clinical one, and therefore, suspicion must be high. Furthermore, a lack of hemodynamic instability does not necessarily preclude the diagnosis of tamponade. By combining their clinical findings and pathologic examination, they reached a purely descriptive diagnosis: B-cell lymphoma of follicular center cell origin. A high cure rate for aggressive B-cell lymphomas, such as diffuse large B-cell lymphoma, can be achieved with the standard of care, a combination of rituximab, cyclophosphamide, hydroxydaunomycin, vincristine, and prednisone.