Primary cardiac diffuse large B-cell lymphoma patient: clinical, histologic, immunophenotypic feature and a novel surgical technology: a case report.

Background: Primary cardiac lymphoma (PCL) is a rare malignancy, representing a small fraction of primary cardiac tumors. Non-germinal center B-cell (non-GCB) diffuse large B-cell lymphoma (DLBCL), a subtype of PCL, often presents with severe symptoms due to its cardiac involvement, and poses diagnostic and therapeutic challenges. This case highlights the use of an innovative surgical approach in managing a non-GCB primary cardiac DLBCL.

Case presentation: We report the case of a 68-year-old woman presenting with palpitations, dizziness, and obstructive cardiac symptoms. Diagnostic imaging revealed a large mass in the right atrium near the superior vena cava. A novel "zongzi"-shaped endoscopic gauze folding technique was employed to facilitate complete tumor resection while preserving cardiac structure. Pathology confirmed double expressor DLBCL with BCL2 and MYC co-expression, indicating a high-risk profile. The patient's postoperative course was uneventful, and she was discharged in stable condition. However, follow-up imaging at six months revealed local disease progression.

Conclusions: This case underscores the challenges in managing primary cardiac DLBCL and highlights the potential of novel surgical techniques to improve resection outcomes while minimizing structural damage to the heart. Further research is essential to optimize multimodal approaches, particularly for aggressive PCL subtypes like double expressor lymphoma.