An Asian man around 70 years-old with a 5 months history of atrial fibrillation visited
to our hospital due to shortness of breath and leg edema. He had a cardiomegaly and
bilateral pleural effusion on his chest X-ray, and had elevated BNP level. CT scan
revealed a giant cardiac tumor around the tricuspid valve. On echocardiographic examination,
the tumor had infiltrated to the right atrium and free wall of the right ventricle,
and protruded into the right atrial cavity. A large amount of pericardial effusion
was also seen. During hospitalization, he developed a cardiac tamponade, and emergent
pericardiocentesis was performed. The pericardial effusion was bloody and class V
in cytology. PET scan was positive in the right axillary lymph node, and its histological
examination revealed diffuse large B-cell lymphoma. Complete remission was obtained
after R-CHOP therapy, and the large tumor was disappeared. More than two years has
passed without recurrence since then. Although many cases with cardiac lymphoma has
been reported, not so many cases had a large protruding mass into the right atrial
cavity. Our experience that a large intracardiac tumor was completely treated by R-CHOP
therapy without surgery may be clinically useful to determine therapeutic strategy
of diffuse large B-cell lymphoma.
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