inline image

A 65-year-old woman was admitted with a 3-week history of general malaise, abdominal pain and fullness, and weight loss. On physical examination there was a palpable mass in the right pelvis, without superficial lymphadenopathy. Computerized tomography (CT) scan of the abdomen showed diffuse retroperitoneal, mesenteric and bilateral iliac lymphadenopathy. A diagnosis of diffuse large B-cell lymphoma (DLCL) was obtained by laparotomy. A staging CT scan of the thorax showed a mass in the right atrium of the heart (top). Echocardiography confirmed the presence of a solitary, smooth-surfaced, globular intracavitary mass attached to a stalk located in the right atrium, suggesting a myxoma (bottom). There was no pericardial involvement. Doppler examination showed normal cardiac function. An electrocardiogram showed a sinus rhythm of 110 beats per min without other alteration. Heart surgery was performed and the mass was excised with a diagnosis of DLCL. The patient was discharged on the 12th postoperative day. Fifteen days later she started standard chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP). Unfortunately, after an initial partial response to chemotherapy, she died of progressive disease 4 months later, but without evidence of cardiac progression.