Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Radiographics. 2012 Sep-Oct;32(5):1369-80. doi: 10.1148/rg.325115126.
Lymphoma of the heart and pericardium is usually present as one aspect of disseminated disease and rarely occurs as a primary malignancy. It accounts for 1.3% of primary cardiac tumors and 0.5% of extranodal lymphomas. Cardiac lymphomas are most commonly diffuse large cell lymphomas and frequently manifest as an ill-defined, infiltrative mass. Atrial location is typical; the right atrium is most often affected. Pericardial thickening or effusion is often a common early feature of disease. Infiltration of atrial or ventricular walls with extension along epicardial surfaces is also a notable feature. At computed tomography, the attenuation of cardiac lymphoma may be similar to or lower than that of normal myocardium. At magnetic resonance imaging, it has variable signal intensity and contrast enhancement. Clinical manifestations may include pericardial effusion, cardiac arrhythmias, and a variety of nonspecific electrocardiographic abnormalities, notably first- to third-degree atrioventricular block. Treatment most commonly includes anthracycline-based chemotherapy and anti-CD20 treatment. Chemotherapy has been used alone or combined with radiation therapy. Palliative surgery has been performed, mainly for tumor debulking. The prognosis for patients with either primary or secondary lymphomatous heart involvement is usually poor; late diagnosis is one of the major factors affecting outcome.
心脏和心包淋巴瘤通常是全身性疾病的一个表现，很少作为原发性恶性肿瘤发生。它占原发性心脏肿瘤的 1.3%和结外淋巴瘤的 0.5%。心脏淋巴瘤最常见的是弥漫性大 B 细胞淋巴瘤，常表现为边界不清的浸润性肿块。心房部位是典型的；右心房最常受累。心包增厚或积液通常是疾病的早期特征。在心包表面的延伸浸润也是一个显著特征。在计算机断层扫描中，心脏淋巴瘤的衰减可能与正常心肌相似或低于正常心肌。在磁共振成像中，它具有不同的信号强度和对比增强。临床表现可能包括心包积液、心律失常和各种非特异性心电图异常，特别是一至三度房室传导阻滞。治疗方法通常包括基于蒽环类药物的化疗和抗 CD20 治疗。化疗单独或与放射治疗联合使用。姑息性手术已经被实施，主要是为了肿瘤减瘤。原发性或继发性淋巴瘤性心脏受累患者的预后通常较差；晚期诊断是影响预后的主要因素之一。
