Malignant Lymphoma Presenting as a Cardiac Tumor.

Abstract

SUMMARYWe report a case of malignant lymphoma whose initial symptoms were heart failure. An echocardiogram showed a large tumor in the right ventricle, and a definitive diagnosis was obtained at autopsy. Of particular interest in our case, the lymphoma was confined to the heart and a mediastinal lymph node, with its greatest bulk being intracardiac. This case is a rare manifestation of malignant lymphoma. (Jpn Heart J 35: 111-115, 1994) Key words:Cardiac tumor Malignant lymphoma Ga scintigraphy ARDIAC involvement of malignant lymphoma is not rare, accounting for approximately 20 per cent of all patients autopsied with this type of neoplasm.1) However, the vast majority of these patients also have widespread extracardiac lesions and do not have symptoms referable to cardiac involvement.2) Lymphomas initially presenting with cardiac symptoms and as a cardiac tumor are, in contrast, extremely rare. We describe one such case here. CASE REPORTA 64-year-old man was admitted because of a right ventricular mass and pericardial effusion. Five weeks before admission he began to experience dyspnea on exertion caused by climbing one flight of stairs, and pretibial edema. Three weeks before entry he was admitted to another hospital, where two-dimensional echocardiography demonstrated a right ventricular mass and massive pericardial effusion. Two weeks later systemic arterial pressure fell and pericardial drainage by pericardiotomy was performed. Cytological examination of the fluid and biopsy of the pericardium at this time did not reveal any specific pathological findings. He was referred to our hospital.On physical examination, the patient appeared moderately ill. The blood pressure was 130/86mmHg, the pulse was 110/min and regular. No lymphadenopathy or rash was found. The jugular venous pressure was moderFrom the

Secondary Cardiac Lymphoma Presenting as Sick Sinus Syndrome and Atrial Fibrillation Which Required Leadless Pacemaker Implantation

“…Therefore, the possibility of cardiac involvement of lymphoma should be acknowledged in patients presenting with sick sinus syndrome with unknown causes ( 6 ). The cardiac involvement of lymphoma is often subclinical ( 7 , 8 ), therefore cardiac involvement as an initial presentation of malignant lymphoma is rare ( 9 ). Our patient initially presented with syncope and palpitation, and his ECG showed atrial fibrillation and sick sinus syndrome.…”

Cardiac Involvement in Non-Hodgkin Lymphoma, an Incidental Large Atrial Mass: A Case Report

“…Secondary involvement of the heart has seen in 8.7 - 27.2% of documented clinical case of lymphoma ( 2 , 6 , 7 ). Despite its life-threatening nature ( 8 ), the cardiac manifestations of lymphomatous involvement of the heart were often subclinical ( 9 , 10 ). As in the present case there has been no cardiac symptom or sign.…”

Primary cardiac lymphoma diagnosed by percutaneous intracardiac biopsy with combined fluoroscopic and transesophageal echocardiographic imaging

“…However, histologic evaluation is generally required prior to initiation of potentially toxic chemotherapy and to guide the assessment for possible surgical resection. Transvenous intracardiac tumor biopsy has been demonstrated as a minimally invasive technique for obtaining diagnostic tissue samples [27,28,[43][44][45][46][47][48][49][50][51][52][53][54][55], including left-sided samples [46]. This technique has been safely used in critically ill patients, small children [56 -58], pregnant women [59], and even dogs [60].…”

“…Published cases of endomyocardial biopsy not guided by echo have resulted in nondiagnostic specimens [2] and usually prompt thoracotomy [59,78]. Indeed, tissue samples obtained by percutaneous biopsy without simul- taneous echocardiographic guidance were nondiagnostic in one case of malignant cardiac lymphoma [47]. This occurred despite extensive involvement of the right ventricular free wall, tricuspid annulus, and right atrial free wall, and the diagnosis was not established until autopsy.…”