Primary lymphoma of the heart: prolonged survival with early systemic therapy in a patient

Lymphomas are tumors of the lymphatic tissues and may occur in many places within the body. Lymphoma of the heart is rare, and has a particularly poor prognosis; in many cases the patients die before the condition is diagnosed and in other cases within two or three weeks despite prompt treatment. In such cases, however, it might be imagined that the aggressiveness of this tumor is only part of the reason for the poor outcome; delay in diagnosis seems likely to have played an important part as well. A case has now been seen in which early diagnosis may have helped a patient with lymphoma of the heart to enjoy longer survival. The patient was a 64-year-old woman who developed chest pain, nausea, shortness of breath, and profuse sweating. Physical examination revealed nothing unusual, but electrocardiographic examination revealed heart abnormalities and a temporary pacemaker was required after the patient developed compete heart block. When ultrasound imaging was used to examine the patient's heart, signs of fluid collecting in the pericardium surrounding the heart were seen. This finding was confirmed with CT scan, which also showed a vague mass next to the heart. The pericardial fluid was sampled and malignant cells were discovered. Imaging techniques revealed no indications of lymphoma elsewhere in the body, and bone biopsies uncovered no signs of lymphoma. The patient was treated with the chemotherapeutic drugs cyclophosphamide, doxorubicin, vincristine, and prednisone, and CT scan revealed a reduction of about 75 percent in the mass by the heart. The patient remains alive more than 18 months after completion of therapy. The characteristics of the lymphoma in this patient were similar to those in other patients who died rapidly. The initiation of chemotherapy, which in this case began within three days of the patient's presentation, is most likely responsible for the long survival of this patient. At present, this woman seems to be the longest survivor of lymphoma of the heart. (Consumer Summary produced by Reliance Medical Information, Inc.)