心臓浸潤を認めた悪性リンパ腫  [in Japanese] Malignant lymphoma with cardiac involvement  [in Japanese]

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Abstract

<p>心臓浸潤を伴う悪性リンパ腫は,その特殊な発症部位と稀な発症頻度から診断の遅れや治療選択に苦慮することが多い。今回我々は当院で経験された3例の臨床的特徴と治療経過について報告する。症例は32歳,74歳,64歳の男性で,3例とも右心系に心臓病変の主座を認めた。CTガイド下生検および開胸生検を施行し,1例は縦隔原発大細胞型B細胞性悪性リンパ腫,残る2例はびまん性大細胞型B細胞性リンパ腫と診断された。3例とも心不全・不整脈の合併を認め,化学療法後の心不全・不整脈等の症状の一時的増悪の懸念から慎重を期して治療強度の低い化学療法あるいはステロイド投与から開始したが,後には治療強度を高めることによって2例で寛解導入が可能であった。心臓病変の存在により心不全および不整脈の合併を認める際は,悪性リンパ腫の可能性も念頭に迅速な画像診断・組織学的検索が必要であり,確定診断後には重篤な合併症なく化学療法が施行可能である。</p>

<p>Malignant lymphoma with cardiac involvement is difficult to diagnose and treatment selection decisions can be challenging, because patients usually present with atypical disease involvement and the incidence is low. Herein, we describe the clinical characteristics and courses of three non-Hodgkin lymphoma patients showing cardiac involvement. All three patients were male, ages 32, 74 and 64 years. All three patients had presented with cardiac involvement mainly in the right heart system. We promptly performed needle biopsies for patients 1 and 3, and open-heart biopsy for patient 2, which showed PMBL for patient 1, DLBCL for patients 2 and 3. Since we were concerned regarding possible transient exacerbation of heart failure or the occurrence of fatal arrhythmia, we chose to start with relatively low dose chemotherapeutic interventions or pre-phase steroid therapy. After one course of chemotherapy or pre-phase steroid therapy, symptoms associated with heart failure almost completely subsided, and we further administered full-dose chemotherapy thereafter, resulting in complete responses in 2 cases. This case series demonstrates that malignant lymphoma with cardiac involvement is a treatable disease, despite widespread involvement. Furthermore, rapid and appropriate diagnostic imaging and biopsy are important when this disease is suspected.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 58(3), 239-242, 2017

    The Japanese Society of Hematology

Codes

  • NII Article ID (NAID)
    130005549372
  • NII NACSIS-CAT ID (NCID)
    AN00252940
  • Text Lang
    JPN
  • ISSN
    0485-1439
  • NDL Article ID
    028086179
  • NDL Call No.
    Z19-295
  • Data Source
    NDL  J-STAGE 
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