Treatment of malignant primary cardiac lymphoma with tumor resection using minimally invasive cardiac surgery

Abstract

BackgroundPrimary cardiac lymphoma (PCL) is extremely rare and progresses rapidly. The treatment of PCL has not yet been established. Unlike lymphoma that arises from other organs, PCL causes cardiovascular events. We report the complete remission (CR) of PCL after tumor resection using minimally invasive cardiac surgery (MICS) and chemotherapy.Case presentationThe patient was a 79-year-old man who visited our hospital with chief complaints of weight loss and leg edema. A 40 × 30 mm mobile pedunculated tumor continuous with the right ventricular heart muscle was present in the right atrium upon echocardiography and extended cardiac surgery was difficult to perform. Tumor embolism-induced sudden death was prevented and a pathological diagnosis was obtained by making a 4-cm skin incision, and tumor resection with MICS was performed through a right fourth intercostal thoracotomy with a cardiopulmonary system. The histopathological diagnosis was diffuse large B cell malignant lymphoma. Eight cycles of postoperative rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy were performed. Three years after surgery, the tumor was not visible on imaging and CR was maintained.ConclusionsThis case highlights that tumor resection using MICS is effective for avoiding the risk of sudden death. This technique was useful for the diagnosis and treatment of a malignant cardiac tumor in an elderly patient that required a difficult extended cardiac surgery.Electronic supplementary materialThe online version of this article (10.1186/s13019-018-0778-6) contains supplementary material, which is available to authorized users.

The incidence and survival outcomes of patients with primary cardiac lymphoma: A SEER‐based analysis

“…In addition, this strategy helps confirm the diagnosis and determine the pathological type needed in determining further chemotherapy. Minimally invasive cardiac surgery has also been attempted to avoid difficult extended cardiac surgery 22 . We further included the treatment modality in the multivariate analysis.…”

“…Minimally invasive cardiac surgery has also been attempted to avoid difficult extended cardiac surgery. 22 We further included the treatment modality in the multivariate analysis. Chemotherapy combined with surgery can reverse the OS and CSS of patients with PCL, but the prognosis of patients with surgery only is not significantly improved.…”

Minimally invasive approaches to primary cardiac tumors: A systematic review and meta‐analysis

“…While a majority of patients included in this study had benign cardiac tumors, it worth noting that the use of MI has been described in literature in the context of primary malignant tumors. 26 The MI approach has largely been utilized with benign tumors rather than malignant tumors probably due to the greater ease of resection, the less invasive nature of benign tumors, and the lack of need for very F I G U R E 3 Risk of bias analysis complex cardiac reconstructions, which would be difficult with MI access.…”

Nomograms and risk classification systems predicting overall and cancer‐specific survival in primary malignant cardiac tumor

“…Due to the rarity of PMCTs, with an incidence of 34 to 131 cases per 100 million people, 1,4 a large randomized controlled trial is not feasible. The previous studies mainly were restricted to case reports, [5][6][7] small case series, [8][9][10] single-center studies 11,12 , and autopsy studies. 13 A population-based database study that pools participants from multiple centers is feasible and can potentially offer more convincing results.…”