Malignant lymphoma: cardiac involvement at initial presentation

Malignant lymphoma rarely involves the heart at initial presentation. We have cared for nine cases in the past 8 years. The median age was 45 years (range, 27 to 68). Initial presenting symptoms included chest pain in four, gastrointestinal (GI) symptoms in three, and constitutional "B" symptoms in two. Echocardiography was the most useful noninvasive procedure, and was abnormal in the eight cases studied. Echocardiographic findings included pericardial effusion in six, and mass lesions within the heart in five. Morphologically, the lymphoma was high-grade small noncleaved in four, immunoblastic sarcoma in one, and diffuse large-cell type in four. Clinical staging workup revealed widely disseminated disease in seven. In spite of multiagent chemotherapy, survival was short (median, 1.5 months). Interestingly, four of these patients were homosexual or bisexual men, who fulfill the criteria for acquired immune deficiency syndrome (AIDS).