Li Y H, Shi C Y, Duan F Q, Pang Y, Li H B, Zhang L Q, Liu Z H, Ouyang L, Yue C Y, Xie M C, Jiang Z J, Xiao Y
Department of Hematology, Guangzhou Military Command Guangzhou General Hospital, Guangzhou 510010, China.
Zhonghua Xue Ye Xue Za Zhi. 2017 Feb 14;38(2):102-106. doi: 10.3760/cma.j.issn.0253-2727.2017.02.004.
To analyze the morbidity, clinical characteristics, therapeutic outcomes and prognosis of cardiac lymphoma. Individual patient data were obtained from pathology defined 10 cases of cardiac lymphoma from Jan 2000 to Jun 2016. The patient's general information, clinical manifestation, pathological diagnosis, laboratory examination, cardiac involvement feature, cardiac complications, treatment, therapeutic effect and prognosis were analyzed. Of 3 918 cases of lymphoma patients, 10 cases of cardiac involvement were identified, including primary cardiac lymphoma (PCL) in 1 case, secondary cardiac lymphoma (SCL) in 9 cases. Of the 10 patients in our analysis, the male-to-female ratio was 3∶2, with a median age of 55 (19-88) years old. The most presenting complaints were dyspnea in 7 cases, followed by chest pain in 5 cases, fatigue in 2 patients and edema in 2 cases. Pathological types included diffuse large B cell lymphoma (DLBCL) in 7 cases, T cell lymphoma (T-LBL) in 1 case, Hodgkin's lymphoma (HL) in 1 case, and Burkitt lymphoma (BL) in 1 case. The sites of the heart affected by lymphoma in the PCL patient were right and left atriums with multiple nodules; and for SCL, the sites were mainly pericardium associated with a pericardial effusion in 5 cases, a pericardial mass in 2 cases. Congestive heart failure affects 7 patients and cardiac arrhythmias were identified in 4 cases mainly sinus tachycardia, atrial fibrillation and atrioventricular block. Except one untreated because of old age and poor performance, the rest of 9 patients were treated by either chemotherapy in 4 cases or chemotherapy combined radiotherapy (including the extracardiac sites) in 5 patients. With the median follow-up of 9 months, the one PCL patient achieved partial response (PR) , progress free survival (PFS) for 6 months and the overall survival (OS) for 21 months; in the cohort of 6 SCL patients cardiac involved at diagnosis, complete response (CR) was achieved in 1 case (16.7%) , PR in 3 cases, progressing disease (PD) in 2 cases, with the median PFS for 5 months and the median OS for 19 months; and for the other 3 SCL patients cardiac involved at progression, PR was achieved in 2 case and death in 1 case, with the median PFS for 4 months and the median OS unavailable because of censored data. Cardiac lymphoma represents a rare subset of lymphoma, the most common type is DLBCL, and the main clinical manifestations are dyspnea and chest pain, always combined by arrhythmia and congestive heart failure. The main therapeutic regimen for cardiac lymphoma includes combined chemotherapy and the prognosis for patients with either PCL or SCL is usually poor.
分析心脏淋巴瘤的发病率、临床特征、治疗效果及预后。收集2000年1月至2016年6月间经病理确诊的10例心脏淋巴瘤患者的个体病例数据。分析患者的一般信息、临床表现、病理诊断、实验室检查、心脏受累特征、心脏并发症、治疗方法、治疗效果及预后。在3918例淋巴瘤患者中,发现10例有心脏受累,其中原发性心脏淋巴瘤(PCL)1例,继发性心脏淋巴瘤(SCL)9例。在我们分析的10例患者中,男女比例为3∶2,中位年龄为55(19 - 88)岁。最常见的主诉为呼吸困难7例,其次为胸痛5例,乏力2例,水肿2例。病理类型包括弥漫大B细胞淋巴瘤(DLBCL)7例,T细胞淋巴瘤(T - LBL)1例,霍奇金淋巴瘤(HL)1例,伯基特淋巴瘤(BL)1例。PCL患者心脏受淋巴瘤影响的部位为左右心房,有多个结节;SCL患者主要累及心包,5例伴有心包积液,2例有心包肿块。充血性心力衰竭影响7例患者,4例发现心律失常,主要为窦性心动过速、心房颤动和房室传导阻滞。除1例因年龄大、身体状况差未治疗外,其余9例患者中,4例接受化疗,5例接受化疗联合放疗(包括心脏外部位)。中位随访9个月,1例PCL患者达到部分缓解(PR),无进展生存期(PFS)为6个月,总生存期(OS)为21个月;在诊断时心脏受累的6例SCL患者队列中,1例(16.7%)达到完全缓解(CR),3例PR,2例疾病进展(PD),中位PFS为5个月,中位OS为19个月;另外3例在疾病进展时心脏受累的SCL患者中,2例PR,1例死亡,中位PFS为4个月,由于数据删失,中位OS无法得出。心脏淋巴瘤是淋巴瘤的罕见亚型,最常见类型为DLBCL,主要临床表现为呼吸困难和胸痛,常伴有心律失常和充血性心力衰竭。心脏淋巴瘤的主要治疗方案包括联合化疗,PCL或SCL患者的预后通常较差。