[Non-Hodgkin's lymphoma; initially presenting cardiac symptoms]

Two long surviving cases of cardiac lymphoma are reported. The first case was an 83-year old man with complete A-V block, congestive heart failure, and pleural effusion. Echocardiography revealed a widespread tumor from the right ventricular wall to the inner space. Cytological examination of pleural effusion showed B-cell type lymphoma. He was treated with systemic chemotherapy and achieved partial remission, continuing for more than 12 months. The second case was a 50-year old man with superior vena cava syndrome caused by a cardiac tumor occupying the whole right atrium. He was treated with partial resection of the tumor and pathological examination showed B-cell type lymphoma. Then he was treated with systemic chemotherapy for massively residual lymphoma, and achieved partial remission, continuing for more than 20 months. Both cases are in good condition under maintenance chemotherapy. In general, malignant lymphoma which is initially presenting cardiac symptoms (so called "cardiac lymphoma") is not so frequent to diagnose premortally, and its prognosis is poor because of delay of diagnosis due to the location of tumor. In addition, insufficient chemotherapy to avoid cardiac rupture or embolism of the pulmonary artery also tend to make the prognosis poor. Recently, several successful cases of cardiac lymphoma treated with systemic chemotherapy have been reported owing to the progress an diagnostic techniques, including echocardiography, CT scan, Ca-scintigraphy and MR imaging. Our experience also indicated that early diagnosis and intensive systemic chemotherapy can obtain long survival in cases of cardiac lymphoma.