Involvement of the heart by malignant lymphoma: a clinicopathologic study.

Although involvement of the heart by malignant lymphoma is relatively common, it is difficult to detect antemortem, and only a small number of studies discuss this subject in the literature. The authors reviewed the 150 patients with malignant lymphoma autopsied at this hospital and studied the 13 (8.7%) who were found to have metastases to the heart or parietal pericardium. Four patients had Hodgkin's disease, and nine non-Hodgkin's lymphoma. Cardiac or pericardial disease apparently resulted from retrograde lymphatic spread, hematogenous spread, and direct extension from other intrathoracic tumor masses. In two cases, lymphomatous involvement of the heart and pericardium was the immediate cause of death; in one of these, myocardial infiltration was detected during life. For the group as a whole, the signs and symptoms of cardiac dysfunction were typically absent or nonspecific, and electrocardiograms and thallium imaging were not effective screening tools for lymphoma metastases. The findings suggest, however, that the most destructive form of cardiac involvement is that associated with direct epicardial spread, and that this form appears with cardiac dysfunction, which should clinically suggest its presence.