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Malignant lymphoma with cardiac involvement
Seitaro Terakura1, Masaaki Onji, Chisako Iriyama
1Department of Hematology, Nagoya University Hospital.
Insights
Diagnosing cardiac lymphoma is challenging due to atypical presentations. This case series shows that prompt diagnosis and treatment of cardiac lymphoma, including primary mediastinal B-cell lymphoma and diffuse large B-cell lymphoma, can lead to complete remission.
Area of Science:
- Cardiology
- Oncology
- Pathology
Background:
- Malignant lymphoma involving the heart presents diagnostic and therapeutic challenges due to low incidence and atypical manifestations.
- Cardiac lymphoma often affects the right heart system, complicating patient presentation.
Abstract:
Malignant lymphoma with cardiac involvement is difficult to diagnose and treatment selection decisions can be challenging, because patients usually present with atypical disease involvement and the incidence is low. Herein, we describe the clinical characteristics and courses of three non-Hodgkin lymphoma patients showing cardiac involvement. All three patients were male, ages 32, 74 and 64 years. All three patients had presented with cardiac involvement mainly in the right heart system. We promptly performed needle biopsies for patients 1 and 3, and open-heart biopsy for patient 2, which showed PMBL for patient 1, DLBCL for patients 2 and 3. Since we were concerned regarding possible transient exacerbation of heart failure or the occurrence of fatal arrhythmia, we chose to start with relatively low dose chemotherapeutic interventions or pre-phase steroid therapy. After one course of chemotherapy or pre-phase steroid therapy, symptoms associated with heart failure almost completely subsided, and we further administered full-dose chemotherapy thereafter, resulting in complete responses in 2 cases. This case series demonstrates that malignant lymphoma with cardiac involvement is a treatable disease, despite widespread involvement. Furthermore, rapid and appropriate diagnostic imaging and biopsy are important when this disease is suspected.