心侵襲を主体とし心臓原発と考えられた悪性リンパ腫の1例

A Case which Look upon Malignant Lymphoma with Massive Cardiac Involvement

　症例は85歳，女性．1992年12月5日頃より呼吸困難が出現12月8日近医を受診し肝機能障害を指摘された．12月10日頃より呼吸困難が増悪し起座呼吸も出現するようになり，12月16日当院入院となった．胸部X線写真上では，両側胸水の貯留を認めた．心エコーでは，多量の心嚢液の貯留と心外膜より心室内腔に突出する形態の腫瘤を認めた．更に，胸水，心嚢液細胞診より悪性リンパ腫細胞class Vを検出し，心臓原発の悪性リンパ腫が疑われた．ステロイド，アルカロイドによる治療の結果，臨床症状は改善したが，12月29日突然の血圧低下にて死亡した．心侵襲を主体とし心臓原発が疑われた悪性リンパ腫の報告は少なく，貴重な1例と考えられたので，ここに報告した．

Though malignant lymphoma is not a rare disease, cardiac malignant lymphoma is rare. The authors report the case of a 85-year-old female with primary malignant lymphoma involving the heart. The patient noticed dyspnea which gradually worsened until about 2 weeks before admission. At the time of admission the patient showed dominant orthopnea. The chest X-ray film revealed marked cardiomegaly associated with pleural effusion of both lung fields. Echocardiogram revealed pericardial effusion and roundshaped mass effect at the epicardium. On computed tomographic study of the chest, the location of the mass effect was identified at the superior anterior mediastinum. Mass effect was not identified on computed tomographic study of the abdomen. Cytological diagnosis of pericar-dial and pleural effusion revealed the presence of malig-nant lymphoma cell (class V). From these findings, pericarditis due to malignant lymphoma was diagnosed. The patient was treated with steroid and alkaloid. 1 week after the drugs administration had been started, her general condition seemed to improve. But after her blood pressure decreased suddenly she died of cardiac tamponade supposedly due to gross hemorrhage into the pericardium. Though autopsy could not be obtained, malignant lymphoma of cardiac origin was strongly suspected. From the literature, this type of malignant lymphoma is extremely rare and so deserved to be reported.