Non-Hodgkin's malignant lymphoma of the bone with intracavitary cardiac involvement

An 84-year-old man with non-Hodgkin's malignant lymphoma presented with a pathological fracture of the femur and also an intra-atrial mass on echocardiography. The patient was given palliative low-dose chemotherapy, but died of tumor dissemination, hypercalcemia, and dehydration. Autopsy revealed diffuse large B-cell lymphoma involving multiple bones and lymph nodes (the latter were not detected during staging), and a solitary mass on the posterior wall of the right atrium. This rare lesion appeared to be due to hematogenous spread, since the myocardium and pericardium were free of tumor infiltration. A literature review indicated that the frequency of cardiac involvement differed between contemporary and earlier reports, mainly due to the availability of increasingly sophisticated diagnostic methods and improvements in chemotherapy.