A Case of Malignant Cardiac Lymphoma Presenting with Acute Abdomen: Should We Call This Case Primary Cardiac Lymphoma?

(Department of Cardiovascular Surgery, Kyoto University Hospital, Kyoto, Japan and Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital*, Kyoto, Japan)

Takeshi Shimamoto Toshifumi Takeuchi* Akiyoshi Mikuriya*
Motoyuki Oda*
A 46-year-old woman who originally presented acute abdomen was reffered to us. Her CT scan and echogram showed no abnormal findings in her abdomen. However, A 25-mm tumor-like mass was observed in her right atrium and right lower lobe. Based on the concern that the cardiac tumor might be a risk for embolic events, the tumor in her right atrium was resected under cardiopulmonary bypass in a semi-emergency manner. It was diagnosed as malignant lymphoma of B-cell type by histological examination. Two days after operation, she started to have abdominal pain and CT scan showed free air and a significant amount of effusion in her abdomen. Emergency laparotomy was performed and a single perforation with a tumor mass was observed in her small intestine. Segmentectomy was performed and her postoperative course since then was uneventful. Fifteen days after her initial operation, she was referred to the regional hematology center for chemotherapy. Primary cardiac lymphoma was classically defined as an extranodal lymphoma involving only the heart and/or pericardium; however the currently accepted definition is lymphoma with the vast bulk of the tumor intrapericardial even with small secondary lesions elsewhere. According to this recent definition, several cases with extensive extracardial involvements have been reported as primary cardiac lymphoma and our case marginally could be considered primary. Certain cutoffs must be proposed to quantify extracardiac disease in defining primary cardiac lymphoma.
@Jpn. J. Cardiovasc. Surg. 35: 53-56 (2006)