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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