Sanna P, Bertoni F, Zucca E, Roggero E, Passega Sidler E, Fiori G, Pedrinis E, Mombelli G, Cavalli F
Servizio Oncologico Cantonale, Ospedale San Giovanni, Bellinzona, Switzerland.
Ann Hematol. 1998 Jul-Aug;77(1-2):75-8. doi: 10.1007/s002770050416.
We report a case of secondary heart involvement in AIDS-related primary lymphoma of the liver. A worsening dyspnea led to the diagnosis of pericardial effusion, and transesophageal echocardiography revealed the presence of large endocardial ventricular masses. Clinical suspicion of a lymphomatous origin was confirmed at the autopsy, which showed an extranodal dissemination pattern (heart, liver, intestine, and lung). In AIDS patients, both primary and secondary lymphomatous heart involvement are increasing in incidence. Clinical symptoms and signs are vague. Since the hematogenous route is the most common pattern of involvement, even extrathoracic lymphomas can present heart dissemination. Thus, it should be suspected in lymphoma patients who present with even mild aspecific heart symptoms. Appropriate imaging procedures include transesophageal echocardiography and, if possible, ECG-gated MRI. A negative transthoracic echocardiograph does not exclude the presence of myocardial tumor. Chemotherapy is only occasionally beneficial, and the prognosis remains poor.
我们报告了一例艾滋病相关的原发性肝淋巴瘤继发心脏受累的病例。进行性加重的呼吸困难导致心包积液的诊断，经食管超声心动图显示心室内膜有巨大肿块。尸检证实临床怀疑的淋巴瘤起源，显示为结外播散模式（心脏、肝脏、肠道和肺）。在艾滋病患者中，原发性和继发性淋巴瘤累及心脏的发生率均在增加。临床症状和体征不明确。由于血行播散是最常见的受累途径，即使是胸外淋巴瘤也可出现心脏播散。因此，对于出现即使是轻微非特异性心脏症状的淋巴瘤患者也应怀疑有心脏受累。合适的影像学检查包括经食管超声心动图，如有可能，还包括心电图门控磁共振成像。经胸超声心动图检查结果阴性并不能排除心肌肿瘤的存在。化疗仅偶尔有益，预后仍然很差。
