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J Thorac Cardiovasc Surg 1994;108:188-189
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

Surgical treatment for primary lymphoma of the heart simulating prosthetic mitral valve thrombosis

B. Albat, MD, P. Messner-Pellenc, MD, A. Thévenet, MD

Department of Cardiovascular Surgery and Cardiology
University Hospital
Montpellier, France

To the Editor:

Primary malignant lymphomas involving only the heart are rare tumors. They are rarely diagnosed ante mortem and produce a variety of clinical manifestations. Surgical removal of this rare tumor has been reported only one time. Go 1 We present a new case of resection of primary cardiac lymphoma, which simulated prosthetic mitral valve thrombosis in a 66-year-old woman.

A 66-year-old woman was admitted to the intensive care unit for pulmonary edema after a history of syncope. She had had mitral valve replacement 8 years earlier (St. Jude Medical heart valve 25 M, St. Jude Medical, Inc., St. Paul, Minn.). Transthoracic and transesophageal echography showed a large, mobile left atrial mass ( Fig. 1 ). The patient was taken to the operating room with the diagnosis of valve thrombosis.



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  		Fig. 1. Transesophageal two-dimensional echocardiographic image showing a left atrial mass (arrow). RA, Right atrium; LA, left atrium; LV, left ventricle.

 
The patient was operated on with total cardiopulmonary bypass, moderate hypothermia, and cardioplegia. The left atrium was opened with a long incision in the interatrial groove. No thrombus was found, but a pedicled, polypoid, gray-white tumor was attached to the atrial wall close to the mitral anulus. It was excised with the attachment of the pedicle.

Pathologic examination revealed a 4 by 2.5 by 2 cm firm mass, histologically a large-cell lymphoma ( Fig. 2 ), without myocardium infiltration. The postoperative course was uneventful. Bone biopsy did not show lymphomatous involvement. The computed tomographic scans of the abdomen, thorax, pelvis, and head showed no abnormalities. She did not receive chemotherapy and was symptom free 6 months later, with normal findings on transesophageal echography ( Fig. 3 ).



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  		Fig. 2. Microscopic section showing a large-cell lymphoma.

 


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  		Fig. 3. Transesophageal two-dimensional echocardiographic follow-up study 6 months after the operation. RA, Right atrium; LA, left atrium; LV, left ventricle.

 
Primary lymphoma of the heart is a rare disorder with a poor prognosis. Go 2 In most of the reported cases the diagnosis was made at autopsy or the patient died shortly after diagnosis despite therapy. Go 3 In all reported cases of lymphoma of the heart, the tumor involved a large part of the cardiac wall and treatment consisted of biopsy and chemotherapy. Despite this treatment, the patient usually died within 2 to 3 weeks except in the case reported by Nand and associates, Go 4 whose patient was alive 18 months after diagnosis and aggressive chemotherapy.

The only case of surgical resection for malignant lymphoma of the heart invading the right atrial wall and both venae cavae was reported by Takagi and associates. Go 1 A chemotherapy regimen was instituted in the postoperative period and the patient died of acute pneumonia 234 days after the operation. In our case, the primary lymphoma of the heart was limited and totally excised. Because the patient had a mitral valve prosthesis, chemotherapy seemed to us too aggressive. Regular clinical and transesophageal echographic assessment seems sufficient to detect recurrence. Six months after the operation, the patient was symptom free.

References

  1. Takagi M, Kugimiya T, Fujii T, et al. Extensive surgery for primary malignant lymphoma of the heart. J Cardiovasc Surg 1992;33:570-2.[Medline]
  2. Curtsinger CR, Wilson MJ, Yoneda K. Primary cardiac lymphoma. Cancer 1989;64:521-5.[Medline]
  3. Chou ST, Arkles LB, Gill GD, et al. Primary lymphoma of the heart: a case report. Cancer 1983;52:744-7.[Medline]
  4. Nand S, Mullen GM, Lonchyna VA, Moncada R. Primary lymphoma of the heart: prolonged survival with early systemic therapy in a patient. Cancer 1991;60:2289-92.



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M. M. Quigley, E. Schwartzman, P. D. Boswell, R. L. Christensen, L. A. Gleason, R. W. Sharpe, and T. A. d'Amato
A unique atrial primary cardiac lymphoma mimicking myxoma presenting with embolic stroke: a case report
Blood, June 15, 2003; 101(12): 4708 - 4710.
[Abstract] [Full Text] [PDF]

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