Late relapse of extranodal NK/T-cell lymphoma presenting as an adrenal mass with suspected cardiac involvement

Extranodal natural killer/T-cell lymphoma (ENKTCL), nasal type, is a rare and aggressive subtype of non-Hodgkin's lymphoma that often presents with extranodal involvement. While relapse patterns commonly involve the nasal cavity, lungs or skin, cardiac involvement is rare. We report a late 50-year-old patient with ENKTCL, nasal type, who achieved complete remission following chemotherapy and autologous stem cell transplantation. He remained disease-free for 6 years before presenting with abdominal pain and haematuria. Imaging revealed an isolated right adrenal mass, confirmed as relapsed ENKTCL on biopsy. Shortly after, an incidental cardiac mass was detected, involving the right atrium, right ventricle and pericardium. Though not amenable to biopsy, imaging exhibited the classic coronary vessel floating sign, characteristic of cardiac lymphomas. The patient passed away despite multiple therapeutic and palliative efforts due to a very poor prognosis after cardiac involvement. This case represents the first documented case of relapsed ENKTCL presenting with cardiac involvement.