Conclusion
Malignant lymphoma is generally responsive to chemotherapy, with a
reported response rate of 79% [2]; therefore, chemotherapy is often
selected as a first-line treatment for PCL [3]. However,
chemotherapy requires a large infusion volume, is associated with a
likelihood of pulmonary tumor embolization, and carries a risk of
cardiac tamponade due to tumor hemorrhage. Furthermore, in cases less
responsive to chemotherapy, a growing tumor could cause hemodynamic
instability or fatal cardiac arrhythmia [3]. Our patient had signs
of heart failure (exertional dyspnea and lower limb edema), and his
tumor occupied most of the right heart and caused tricuspid stenosis.
Therefore, we performed tumor resection as quickly as possible to avoid
fatal cardiac events.
Partial tumor resection to relieve the tricuspid stenosis might have
been enough to prevent fatal hemodynamic collapse [5]. However, the
tumor involved the anterior and posterior tricuspid leaflets and was too
fragile to be sutured with biological materials. Therefore, complete
resection of the PCL was required to ensure security of the stitches
within the cardiac tissue. Although the excised end of the tumor was
pathologically positive, subsequent chemotherapy showed promising
efficacy; therefore, two-stage treatment for this patient’s PCL was a
justified strategy [6].
In conclusion, we successfully performed complete surgical tumor
resection and reconstruction of the right atrium and right ventricle
using a bovine pericardial patch for a huge PCL filling the right heart.
Urgent surgery enables timely administration of postoperative
chemotherapy without heart failure.
Acknowledgment: We thank Angela Morben, DVM, ELS, from Edanz
Group (https://en-author-services.edanzgroup.com/ac), for editing a
draft of this manuscript.
Author contribution statement: Takura Taguchi was responsible
for acquisition of the data and writing of the original manuscript.
Satsuki Fukushima, Shin Yajima, and Tomoyuki Fujita made substantial
contributions to the conception of the study and design of this report
and assisted with critical revision of the manuscript. All authors
provided final approval of the version to be published.