Successful management of primary cardiac lymphoma with minimal debulking surgery combined with adjuvant chemotherapy

Primary cardiac lymphoma (PCL) is a rare cardiac tumor with poor prognosis. Palliative chemotherapy is still considered to be the standard management tool for PCL. A case of a 58-year-old man with a large right-heart tumor is presented. Echocardiography showed no abnormal findings except mild tricuspid stenosis with dynamic obstruction. To prevent sudden right heart failure, we pursued on-pump beating resection. After resection of the tumor near the tricuspid valve and confirmation of normalized hemodynamics by intraoperative transesophageal echocardiography, we decided not to perform a further debulking procedure, such as resection or reconstruction of the atrial/ventricular wall. The postoperative course was uneventful and the patient tolerated six cycles of adjuvant chemotherapy well. Currently, the patient visits the outpatient clinic regularly without definite evidence of lymphoma involvement on follow-up imaging studies. In cases where a rare malignant cardiac tumor is suspected, surgical resection should be considered a diagnostic tool for tissue confirmation, a therapeutic tool for hemodynamic correction, and a preventive strategy for sudden cardiac death. Additionally, a minimal debulking procedure focusing on the area of hemodynamic disturbance appears to be sufficient in PCL cases.