Echocardiographic and pathological characteristics of cardiac metastasis in patients with lymphoma

The purposes of this study were to investigate the patterns of lymphoma involvement in the heart and to correlate pathologic findings in the heart at autopsy with echocardiographic presentation prior to death in patients with malignant lymphoma. Lymphoma patients with complete echocardiographic records prior to death and conformed cardiac metastasis at autopsy were included in the study. Echocardiographic records were reviewed retrospectively. Pathological diagnoses were compared with echocardiographic findings using Fisher's exact test. Twenty-nine patients aged 19-71 (mean ± SD, 51.5±12.7) years were included in the study. Among them 17 (58.6%) were male. There were 6 cases (20.7%) with Hodgkin's disease and 23 (79.3%) cases with non-Hodgkin's lymphoma. Twenty-two (75.9%) cases were diagnosed with cardiac metastases at autopsy by gross appearance of their hearts. The most common (41.4%) site of metastatic involvement was the pericardium. The frequency of tumor on the valves was significantly lower than in the chambers and on other parts of the heart (6.9% versus 93.1%). Metastatic masses in right heart were found in 8 (8/23, 34.8%) non-Hodgkin's lymphoma cases, which was higher than that in Hodgkin's lymphoma cases (0/6, 0%; p=0.15). The frequency of high-grade non-Hodgkin's disease metastasizing to the right ventricle was significantly higher than that for the other kinds of lymphoma (3/7, 42.9% versus 0/22, 0%; p=0.01). Sensitivity of echocardiographic examination to detect cardiac metastasis was 75.9%. Echocardiography has been shown to be a sensitive method for the diagnosis of cardiac involvement in the patients with lymphoma. Patterns of cardiac involvement vary by the types of lymphoma, suggesting that different pathologic types of lymphoma may have different mechanisms of metastasis to the heart.