Surgical Approach to Primary Cardiac Malignant Lymphoma Considering Early Initiation of Chemotherapy

A 67-year-old woman was referred for cardiac tumor. Computed tomography scans revealed a large mass occupying the left atrium causing the left pulmonary vein obstruction and pulmonary congestion. Positron emission tomography / computed tomography (PET/CT) showed abnormal accumulation at the border between the left atrium and the left pulmonary vein orifices, and the invasion of the malignant cell to the left upper and lower pulmonary veins was highly suspected. Operative finding was that the tumor was attached to the left atrial posterior wall adjacent to the left pulmonary vein orifices and extended to the left upper pulmonary vein about 1 cm beyond the left upper pulmonary vein orifice. The tumor was not extended to the left lower pulmonary vein. Considering the possibility that the tumor was a sarcoma, for which chemotherapy was less effective, radical resection including left upper lobectomy and reconstruction of the left atrium was considered, but a rapid intra-operative histological exam revealed a malignant lymphoma. Therefore, surgery was performed to reduce the tumor as much as possible. The postoperative course was good and the patient was treated with chemotherapy, surviving for 18 months without any signs of recurrence.