Case Report

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Korean J Hematol 2010; 45(4):

Published online December 31, 2010

https://doi.org/10.5045/kjh.2010.45.4.282

© The Korean Society of Hematology

Long-term disease-free survival of patients with primary cardiac lymphoma treated with systemic chemotherapy and radiotherapy

Dong-Yeop Shin, Yun-Gyoo Lee, Hyun-Jung Lee, Seyoun Choi, Jin Joo Park, and Dong-Wan Kim*

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Correspondence to : Correspondence to Dong-Wan Kim, M.D., Ph.D. Department of Internal Medicine, Seoul National University Hospital, 101, Daehagro, Chongno-gu, Seoul 110-744, Korea. Tel: +82-2-2072-2995, Fax: +82-2-762-9662, kimdw@snu.ac.kr

Received: July 23, 2010; Revised: October 8, 2010; Accepted: November 18, 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Primary cardiac lymphoma (PCL) is a rare disease entity with only a few reported cases in Korea. In this paper, we report a case of PCL in a 59-year-old man presenting with chest pain. Diffuse large B-cell lymphoma was diagnosed through a cardiac catheterization-assisted percutaneous endomyocardial biopsy, and there was no evidence of extracardiac involvement of the lymphoma.The patient had a complete clinical response after systemic chemotherapy with a rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) regimen and additional post-chemotherapeutic radiation therapy. The patient experienced a long-term disease-free survival of over 4 years. However, he received coronary artery bypass graft surgery due to an acute myocardial infarction that occurred 3 years after the completion of the radiation therapy. Although the addition of radiation therapy to the treatment is thought to decrease the risk of relapse in patients with PCL, a careful and thorough consideration of the potential complications of radiation therapy, particularly with respect to cardiac complications, should be considered.

Keywords Lymphoma, Myocardial infarction, Drug therapy, Radiotherapy

Article

Case Report

Korean J Hematol 2010; 45(4): 282-285

Published online December 31, 2010 https://doi.org/10.5045/kjh.2010.45.4.282

Copyright © The Korean Society of Hematology.

Long-term disease-free survival of patients with primary cardiac lymphoma treated with systemic chemotherapy and radiotherapy

Dong-Yeop Shin, Yun-Gyoo Lee, Hyun-Jung Lee, Seyoun Choi, Jin Joo Park, and Dong-Wan Kim*

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Correspondence to: Correspondence to Dong-Wan Kim, M.D., Ph.D. Department of Internal Medicine, Seoul National University Hospital, 101, Daehagro, Chongno-gu, Seoul 110-744, Korea. Tel: +82-2-2072-2995, Fax: +82-2-762-9662, kimdw@snu.ac.kr

Received: July 23, 2010; Revised: October 8, 2010; Accepted: November 18, 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Primary cardiac lymphoma (PCL) is a rare disease entity with only a few reported cases in Korea. In this paper, we report a case of PCL in a 59-year-old man presenting with chest pain. Diffuse large B-cell lymphoma was diagnosed through a cardiac catheterization-assisted percutaneous endomyocardial biopsy, and there was no evidence of extracardiac involvement of the lymphoma.The patient had a complete clinical response after systemic chemotherapy with a rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) regimen and additional post-chemotherapeutic radiation therapy. The patient experienced a long-term disease-free survival of over 4 years. However, he received coronary artery bypass graft surgery due to an acute myocardial infarction that occurred 3 years after the completion of the radiation therapy. Although the addition of radiation therapy to the treatment is thought to decrease the risk of relapse in patients with PCL, a careful and thorough consideration of the potential complications of radiation therapy, particularly with respect to cardiac complications, should be considered.

Keywords: Lymphoma, Myocardial infarction, Drug therapy, Radiotherapy

Fig 1.

Figure 1.

(A) T2-weighted MRI image showing a cardiac mass (arrow) with similar signal intensity compared to the myocardium, and which had invaded the pericardial space and the right atrial wall with an intracardiac extension. (B) Biopsy specimen showing large, atypical lymphoid cells with irregularly shaped nuclei containing clumped chromatin and prominent nucleoli (hematoxylin and eosin stain, ×400). (C) CD20 immunohistochemistry of a biopsy specimen showing diffuse membranous staining. (D) A magnetic resonance image performed after 6 cycles of R-CHOP showing a partial response of the cardiac mass (arrow).

Blood Research 2010; 45: 282-285https://doi.org/10.5045/kjh.2010.45.4.282

Table 1 . Baseline characteristics of the long-term follow-up cases (≥1 year) with primary cardiac lymphoma treated with systemic chemotherapy (Data are from 13 cases, including the present case)..

Abbreviations: DLBL, diffuse large B-cell lymphoma; RA, right atrium; RV, right ventricle..


Table 2 . Long-term outcomes of cases of primary cardiac lymphoma treated with systemic chemotherapy (Data are from 13 cases, including the one detailed in the current case report)..

a)All patients received anthracycline-containing combination chemotherapy..

Abbreviations: PFS, progression free survival; RTx, radiation therapy..


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