心機能異常をきたした副鼻腔原発リンパ肉腫の1例

A Case of Paranasal Sinus Lymphosarcoma with Abnormal Cardiac Manifestations

　I．はじめに

　悪性リンパ腫の心臓への浸潤は，剖検上約24％にみられ決して稀ではないが，心臓浸潤の様式は，癌腫と異なりびまん性に起こるのが一般的で，通常心機能障害も伴わず全く無症状であるため，その生前診断は一般に極めてむずかしいとされている。今回筆者らは，剖検はできなかったが，副鼻腔リンパ肉腫で心臓への浸潤によると思われる種々の房室伝導障害を生じ，末期に白血化をきたした症例を経験したので，若干の文献的考察を加えて報告する．

　A 43-year-old man had operative diagnosis of paranasal sinus lymphosarcoma.

　Postoperatively, he was treated with bleomycin, vincristine, cyclophosphamide and prednilosone weekly for a total of seven cycles and 2000 rads of irradiation to the paranasal sinuses.

　Although massive pericardial effusion disappeared rapidly at the initial stage, he was suspected of having cardiac involvement by the tumor, by developing clinical manifestations of constrictive pericarditis, cardiac arrhythmia and symptoms of angina pectoris. Finally, three tumor masses in the right atrium and one mass in the left atrium were discovered on the ultrasono-tomocardiographic examination.

　Accordingly, it was considered that those signs and symtoms of cardiac disturbance were resulted from myocardial and pericardial involvement of the paranasal sinus lymphosarcoma.