An 84-year-old man with non-Hodgkin's malignant lymphomapresented with a pathological fracture of the femur and also an intra-atrial mass on echocardiography. The patient was given palliative low-dose chemotherapy, but died of tumor dissemination, hypercalcemia, and dehydration. Autopsy revealed diffuse large B-cell lymphoma involving multiple bones and lymph nodes (the latter were not detected during staging), and a solitary mass on the posterior wall of the right atrium. This rare lesion

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... red to be due to hematogenousspread, since the myocardiumand pericardium were free of tumor infiltration. A literature review indicated that the frequency of cardiac involvement differed between contemporary and earlier reports, mainly due to the availability of increasingly sophisticated diagnostic methods and improvements in chemotherapy. (Internal Medicine 32: 502-507, 1993) Key words: bone lesion, cardiac metastasis, malignant, echocardiography, hypercalcemia, pathological fracture Clinical findings His temperature was 36.6°C, pulse rate 76 beats/min with absolute arrhythmia, respiration rate 20/min, and blood pressure 170/80 mmHg.No lymphadenopathy was present in the cervical, axillary, and inguinal nodes. The head and neck were normal, including the bilateral tonsils. The lungs were clear, and no murmurs or extra soundswerenoted on cardiac auscultation. The abdomenwas soft and flat, without detectable hepatosplenomegaly. The left thigh was swollen, but no peripheral edemawas found. Neurological examination was negative, except for sluggish speech and mild hearing disability. The hemoglobin concentration was 13.9 g/dl, platelet count 222 x 103/|nl, and white blood cell count 5,800 /|Lil, with a normal differential count. Biochemistry tests revealed the fol-