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Involvement of the heart by malignant lymphoma: a clinicopathologic study
Insights
Malignant lymphoma rarely causes heart problems detectable before death. Direct spread to the heart
Area of Science:
- Oncology
- Cardiology
- Pathology
Background:
- Malignant lymphoma can infiltrate the heart, but antemortem detection is challenging.
- Cardiac and pericardial involvement by lymphoma is infrequently documented in medical literature.
Purpose of the Study:
- To investigate the incidence and characteristics of cardiac and pericardial metastases in patients with malignant lymphoma.
- To evaluate the clinical and diagnostic challenges associated with lymphoma affecting the heart.
Main Methods:
- Retrospective autopsy review of 150 patients diagnosed with malignant lymphoma.
- Analysis of 13 cases (8.7%) with heart or parietal pericardium metastases.
- Categorization of lymphoma types (Hodgkin's disease and non-Hodgkin's lymphoma) and spread mechanisms.
Main Results:
- Cardiac/pericardial involvement occurred in 13 (8.7%) of 150 lymphoma autopsies.
- Lymphoma spread via lymphatic, hematogenous, or direct extension pathways.
- Cardiac dysfunction was often nonspecific; electrocardiograms and thallium imaging were poor screening tools.
- Direct epicardial spread was the most destructive form, often presenting with cardiac dysfunction.
Conclusions:
- Antemortem diagnosis of cardiac lymphoma is difficult due to nonspecific symptoms.
- Direct epicardial spread of lymphoma is associated with significant cardiac dysfunction.
- Clinical suspicion of cardiac dysfunction should prompt consideration of lymphoma involvement.
Abstract:
Although involvement of the heart by malignant lymphoma is relatively common, it is difficult to detect antemortem, and only a small number of studies discuss this subject in the literature. The authors reviewed the 150 patients with malignant lymphoma autopsied at this hospital and studied the 13 (8.7%) who were found to have metastases to the heart or parietal pericardium. Four patients had Hodgkin's disease, and nine non-Hodgkin's lymphoma. Cardiac or pericardial disease apparently resulted from retrograde lymphatic spread, hematogenous spread, and direct extension from other intrathoracic tumor masses. In two cases, lymphomatous involvement of the heart and pericardium was the immediate cause of death; in one of these, myocardial infiltration was detected during life. For the group as a whole, the signs and symptoms of cardiac dysfunction were typically absent or nonspecific, and electrocardiograms and thallium imaging were not effective screening tools for lymphoma metastases. The findings suggest, however, that the most destructive form of cardiac involvement is that associated with direct epicardial spread, and that this form appears with cardiac dysfunction, which should clinically suggest its presence.