T-cell prolymphocytic leukemia with extensive cardiovascular infiltrate leading to multiple myocardial infarctions and cardiac death

Lymphocytic neoplasm involving the heart is not common and usually presents with pericardial effusion or focal myocardial infiltration. Myocardial infarctions due to leukemic infiltration of the coronary arteries are rarely reported. We present the case of a 52-year-old Guatemalan man with a one-yea...

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Bibliographic Details
Published in:Texas Heart Institute journal 2014-12, Vol.41 (6), p.626-630
Main Authors: Cheng, Hong, Feldman, Tatyana, Butt, Yasmeen, Chow, Kar F, Yang, Xiao Yan, Bhattacharyya, Pritish K, de Vinck, David C
Format: Article
Language:English
Subjects:
Autopsy
Biomarkers, Tumor - analysis
Biopsy
Case Reports
Coronary Stenosis - diagnosis
Coronary Stenosis - etiology
Coronary Vessels - immunology
Coronary Vessels - pathology
Fatal Outcome
Heart Neoplasms - complications
Heart Neoplasms - immunology
Heart Neoplasms - pathology
Humans
Immunohistochemistry
Leukemia, Prolymphocytic, T-Cell - complications
Leukemia, Prolymphocytic, T-Cell - immunology
Leukemia, Prolymphocytic, T-Cell - pathology
Male
Middle Aged
Myocardial Infarction - diagnosis
Myocardial Infarction - etiology
Neoplasm Invasiveness
Recurrence
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Summary:Lymphocytic neoplasm involving the heart is not common and usually presents with pericardial effusion or focal myocardial infiltration. Myocardial infarctions due to leukemic infiltration of the coronary arteries are rarely reported. We present the case of a 52-year-old Guatemalan man with a one-year history of untreated T-cell prolymphocytic leukemia. He was admitted to our hospital for chemotherapy and evaluation of a pulmonary cavitary lesion by wedge resection. During sedation, the patient experienced acute respiratory failure and hypovolemic shock, from which he could not be resuscitated. Autopsy revealed that leukemic cells extensively infiltrated the aorta, myocardium, and coronary arteries. The lumina of the 3 major coronary artery branches showed 70% to 95% stenosis, with multifocal remote myocardial infarctions. Tumor cells were also detected in the lungs and other organs. The acute cardiorespiratory insufficiency secondary to leukemia-particularly the extensive infiltration of the coronary arteries and myocardium, and the multiple myocardial infarctions-eventually resulted in cardiac death.
ISSN:0730-2347
1526-6702
DOI:10.14503/THIJ-13-3581