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Malignant lymphoma demonstrating sick sinus syndrome

M Kamimura¹, N Tanabe, M Hojo

¹Pulmonology Department, International Medical Center of Japan, Tokyo.

Internal Medicine (Tokyo, Japan)

|July 4, 1998

Summary

T-cell-rich large B-cell lymphoma can initially present with sick sinus syndrome and effusions. Autopsy confirmed lymphoma involvement of the sinoatrial node, highlighting a rare cardiac manifestation.

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Area of Science:

Cardiology
Oncology
Pathology

Background:

T-cell-rich large B-cell lymphoma (TRLBCL) is an aggressive non-Hodgkin lymphoma.
Cardiac involvement in lymphomas is uncommon, particularly as an initial presentation.

Observation:

A patient presented with sick sinus syndrome as the sole initial symptom.
Subsequent development of pericardial and pleural effusions was noted.
Intrapleural interferon-alpha temporarily controlled pleural effusion recurrence.

Findings:

Systemic chemotherapy was ineffective against cutaneous and lymph node lymphoma.
Autopsy revealed lymphoma cell infiltration of the sinoatrial node.
This indicates a direct cardiac involvement by TRLBCL.

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Implications:

Sick sinus syndrome may be an early indicator of TRLBCL with cardiac involvement.
This case underscores the importance of considering extranodal lymphoma in unexplained cardiac and effusive syndromes.
Novel therapeutic strategies may be needed for lymphoma involving the cardiac conduction system.