Ottavy Gregoire, Camous Laurent, Fieschi Claire, Torre Lucas Della, Pommier Jean-David
Réanimation Médicale et Chirurgicale, CHU de Guadeloupe, Les Abymes, Guadeloupe, 97139, France.
Immuno-pathologie clinique, CHU Saint Louis, Assistance Publique Hôipitaux de Paris, Paris, 75010, France.
J Cardiothorac Surg. 2025 Jan 4;20(1):17. doi: 10.1186/s13019-024-03261-1.
The medico-surgical management of cardiac tumors when there is a suspicion of malignancy is complex. Moreover, in a critically ill setting, the choice of diagnostic tools seems crucial.
We present the case of a sixty-four-year-old patient with no prior medical history who was admitted to the intensive care unit with obstructive shock secondary to a right heart mass and pulmonary embolism. Clinical and biological features revealed secondary hemophagocytic lympho-histiocytosis (HLH). The patient underwent a diagnostic procedure with dual thoracoscopic and mediastinoscopy with biopsies. Following the diagnosis of primary cardiac lymphoma, the patient received sequential chemotherapy without undergoing cardiac surgery leading to initial improvement, with reductions in intracardiac obstruction and in biomarkers associated with hemophagocytic lympho-histiocytosis.
When a cardiac mass is associated with extracardiac symptoms indicative of a hematological malignancy, the preferred treatment is chemotherapy, and cardiac surgery should be avoided.
当怀疑存在恶性肿瘤时，心脏肿瘤的内科及外科治疗管理较为复杂。此外，在危重症情况下，诊断工具的选择似乎至关重要。
我们报告一例64岁无既往病史的患者，因右心肿块和肺栓塞继发梗阻性休克入住重症监护病房。临床和生物学特征显示为继发性噬血细胞性淋巴组织细胞增生症（HLH）。该患者接受了胸腔镜和纵隔镜联合活检的诊断性操作。在诊断为原发性心脏淋巴瘤后，患者接受序贯化疗，未进行心脏手术，病情初步改善，心内梗阻及与噬血细胞性淋巴组织细胞增生症相关的生物标志物均有所降低。
当心脏肿块伴有提示血液系统恶性肿瘤的心脏外症状时，首选治疗方法为化疗，应避免进行心脏手术。
