Multidisciplinary approach for primary cardiac lymphoma associated with hemodynamic failure caused by tricuspid valve obstruction

Abstract

Primary cardiac lymphoma (PCL) comprises rare cardiac tumors and exhibits rapid growth and poor prognosis. We report the case of a 65-year-old man with PCL associated with unstable hemodynamics caused by tricuspid valve obstruction. Generally, chemotherapy is the first choice of treatment for patients with PCL. This patient required emergency tumor reduction as he was at risk of having acute hemodynamic failure caused by tricuspid valve obstruction. Therefore, he underwent a 2-staged treatment: urgent surgery to avoid sudden death by tricuspid valve obstruction as well as pulmonary embolism during chemotherapy, followed by early chemotherapy. Pathological findings showed diffuse large B-cell lymphoma, and rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, prednisolone (R-CHOP) therapy was initiated to treat any residual tumor infiltrating the myocardial wall. The patient showed a marked clinical improvement. We conclude that surgical tumor reduction and early chemotherapy might be an effective treatment for PCL patients with hemodynamic compromise.<Learning objective: We experienced a case of cardiac lymphoma associated with acute hemodynamic failure caused by tricuspid valve obstruction. The impacted tumor was urgently resected to avoid cardiogenic shock and sudden death, although chemotherapy, not surgery, is generally the first choice of treatment for cardiac lymphoma. The residual tumor showed a good response to the early postoperative chemotherapy. This case report suggests the utility of 2-stage treatment for cardiac lymphoma with hemodynamic failure.>