Non-Hodgkin Lenfomaya Bağlı Konstriktif Perikardit: Perikardiektomi İle Tedavi Edilen Nadir Bir Olgu
Özet
Non-Hodgkin lenfoma (NHL) zemininde gelişen konstriktif perikardit (KP) son derece nadir bir tablodur ve literatürde yalnızca birkaç olgu sunumu mevcuttur. Bu yazıda, iki yıl önce ALK-negatif Anaplastik Büyük Hücreli Lenfoma (ABHL) tanısıyla kemoterapi tamamlayan, ardından inatçı karın distansiyonu ve sağ kalp yetmezliği bulgularıyla başvuran 67 yaşında erkek bir hasta sunulmaktadır. Ekokardiyografide anüler reverz ve septal sıçrama, kardiyak MRG'de perikardiyal kalsifikasyon ve artmış perikardiyal kalınlık saptanarak KP tanısı konuldu. Koroner anjiyografide eş zamanlı LAD ve CX lezyonları tespit edilmesi üzerine total perikardiektomi ve koroner arter baypas greftleme (KABG) tek seansta uygulandı. Histopatolojik incelemede lenfoma hücresi infiltrasyonu saptanmadı; kalsifikasyon ve fibrozisle birlikte nonspesifik kronik inflamasyon görüldü. Ameliyat sonrasında hastanın semptomlarında belirgin klinik düzelme sağlandı. Bu olgu; NHL'li hastalarda perikardiyal kalsifikasyon saptandığında KP gelişme olasılığının akılda tutulması ve ALK-negatif ABHL zemininde gelişen KP'de perikardiektominin etkili bir tedavi seçeneği olduğunu vurgulaması açısından önem taşımaktadır.
Constrictive pericarditis (CP) secondary to Non-Hodgkin lymphoma (NHL) is an extremely rare condition with only a few case reports in the literature. We present a 67-year-old male patient who had completed chemotherapy for ALK-negative Anaplastic Large Cell Lymphoma (ALCL) two years prior and subsequently presented with persistent abdominal distension and right heart failure. Echocardiography revealed annulus reversus and septal bounce, while cardiac MRI demonstrated pericardial calcification and increased pericardial thickness, confirming the diagnosis of CP. Coronary angiography additionally revealed significant LAD and circumflex artery lesions, and the patient underwent total pericardiectomy combined with coronary artery bypass grafting (CABG) in a single session. Histopathological examination of the pericardiectomy specimen showed no lymphoma cell infiltration; instead, nonspecific chronic inflammation with fibrosis and calcification was identified. The patient demonstrated marked clinical improvement in heart failure symptoms postoperatively. This case highlights the importance of considering CP development in NHL patients in whom pericardial calcification is detected, and demonstrates that pericardiectomy is an effective treatment option in CP developing on the background of ALK-negative ALCL.
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