Successful Management of Primary Cardiac Lymphoma with Minimal Debulking Surgery Combined with Adjuvant Chemotherapy

Authors

  • Tae Hee Hong Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
  • Dong Seop Jeong Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul

DOI:

https://doi.org/10.1532/hsf.1317

Abstract

Primary cardiac lymphoma (PCL) is a rare cardiac tumor with poor prognosis. Palliative chemotherapy is still considered to be the standard management tool for PCL. A case of a 58-year-old man with a large right-heart tumor is presented. Echocardiography showed no abnormal findings except mild tricuspid stenosis with dynamic obstruction. To prevent sudden right heart failure, we pursued on-pump beating resection. After resection of the tumor near the tricuspid valve and confirmation of normalized hemodynamics by intraoperative transesophageal echocardiography, we decided not to perform a further debulking procedure, such as resection or reconstruction of the atrial/ventricular wall. The postoperative course was uneventful and the patient tolerated six cycles of adjuvant chemotherapy well. Currently, the patient visits the outpatient clinic regularly without definite evidence of lymphoma involvement on follow-up imaging studies. In cases where a rare malignant cardiac tumor is suspected, surgical resection should be considered a diagnostic tool for tissue confirmation, a therapeutic tool for hemodynamic correction, and a preventive strategy for sudden cardiac death. Additionally, a minimal debulking procedure focusing on the area of hemodynamic disturbance appears to be sufficient in PCL cases.

References

Ceresoli GL, Ferreri AJ, Bucci E, Ripa C, Ponzoni M, Villa E. 1997. Primary cardiac lymphoma in immunocompetent patients: diagnostic and therapeutic management. Cancer 80:1497-506.

Choi WS, Han IY, Jun HJ, Lee YH, Hwang YH, Cho KH. 2008. Primary malignant cardiac lymphoma in right atrium: a case report. Korean J Thorac Cardiovasc Surg 41:369-72.

Fujita Y, Ikebuchi M, Tarui S, Irie H. 2009. Successful combined treatment of primary cardiac malignant lymphoma with urgent cardiac operation and chemotherapy. Circ J 73:967-9.

Gyoten T, Doi T, Nagura S, et al. 2015. Primary cardiac malignant lymphoma: survival for 13 years after surgical resection and adjuvant chemotherapy. Ann Thorac Surg 99:1060-2.

Mo A, Lin H, Wen Z, Lu W, Long X, Zhou Y. 2008. Efficacy and safety of on-pump beating heart surgery. Ann Thorac Surg 86:1914-8.

Nonami A, Takenaka K, Kamezaki K, et al. 2007. Successful treatment of primary cardiac lymphoma by rituximab-CHOP and high-dose chemotherapy with autologous peripheral blood stem cell transplantation. Int J Hematol 85:264-6.

Park KS, Ahn WS, Lee S, Kwon OC, Ko MS, Jheon SH. 2004. Primary non-hodgkin’s lymphoma in right ventricle with right atrial invasion: report of 1 case. Korean J Thorac Cardiovasc Surg 37:376-81.

Petrich A, Cho SI, Billett H. 2011. Primary cardiac lymphoma: an analysis of presentation, treatment, and outcome patterns. Cancer 117:581-9.

Sarjeant JM, Butany J, Cusimano RJ. 2003. Cancer of the heart: epidemiology and management of primary tumors and metastases. Am J Cardiovasc Drugs 3:407-21.

Published

2015-12-09

How to Cite

Hong, T. H., & Jeong, D. S. (2015). Successful Management of Primary Cardiac Lymphoma with Minimal Debulking Surgery Combined with Adjuvant Chemotherapy. The Heart Surgery Forum, 18(6), E242-E244. https://doi.org/10.1532/hsf.1317

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