Letters to the Editor transperineal interstitial brachytherapy for cervical cancer: High Dimopoulos J, et al Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): Concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV Radiother Oncol 2005;74:235-45 pelvic control and low complication rates Int J Radiat Oncol Biol Phys 1999;45:105-12 Haie-Meder C, Pötter R, Van Limbergen E, Briot E, De Brabandere M, An unusual presentation of non-Hodgkin lymphoma: Cardiac involvement Access this article online Website: www.cancerjournal.net Quick Response Code DOI: 10.4103/0973-1482.73329 PMID: *** Sir, A 41-year-old man without any significant medical history was hospitalized in cardiology service for progressive dyspnea, palpitation and continuous weight loss for two months On admission, the patient had an ECOG performance status equal to Physical examination revealed tachycardia with a pulse rate of 95 beats per minute, a blood pressure of 140/80 mmHg, and a murmur due to pericardial friction Clinical examination showed an axillary left node measuring cm Chest X-rays showed left pleural effusion without cardiac hypertrophy Electrocardiogram showed a microvoltage Bi-dimensional transthoracic echocardiography [Figure 1] revealed a nonobstructing mass fixed to the right atrium, without any vegetation, measuring 60 × 40mm, and a second Figure 1: Atrial mass at initial diagnosis lesion attached to the left atrium measuring 50 × 45 mm; with normal left ventricular fonction and free right ventricular Chest computed tomography confirmed tow cardiac mass attached to the atriums, and showed multiple mediastinal nodes, and pleural and pericardial effusion Laboratory investigations showed a normal blood formule Blood cultures and viral serologies (EBV, VHB, VHC, and HIV) were negative Biopsy of the axillary node with histological and immunohistochemistry studies showed DLBCL according to the Revised EuropeanAmerican Classification of Lymphoid Neoplasms/World Health Organisation classification of lymphoid neoplasms (REAL/ WHO).[1] Most of the neoplasic cells were positive for CD-20 Computed tomography of the abdomen and pelvis was normal A bone marrow biopsy showed no abnormalities The patient was staged IV according to the Ann Arbor Staging system The patient received standard Rituximab 375 mg/m² on day 1, Cyclophosphamide 750 mg/m² on day 1, Doxorubicine 50 mg/ m² on day 1, Vincristine 1.4 mg/m² on day 1, and prednisone 50 mg/m² on day to 5, (RCHOP) regimen A bidimensionnal echocardiography after chemotherapy courses showed the complete disappearance of the right and left atrials tumor [Figure 2] and a normal clinical cardiac exam He received cycles of standard chemotherapy with complete clinical and radiological response He remained disease free, until now, Figure 2: Transthoracic echocardiography after cycles of chemotherapy Journal of Cancer Research and Therapeutics - July-September 2010 - Volume - Issue 401 Letters to the Editor end of the cycles of chemotherapy with rituximab months after the end of chemotherapy Secondary involvement of the heart cavity by non-Hodgkin lymphoma is more frequent than primary cardiac nonHodgkin’s lymphoma and represents the third most common malignant tumour of the heart in autopsy studies.[2] The disease may involve all cardiac structures, but lesions of the right heart and particularly the right atrium are predominant.[3] Clinical manifestations are usually non-specific and appear at a late stage, reflecting diffuse involvement Cardiac involvement as an initial presentation of malignant lymphoma is a rare occurrence.[4] Three mechanisms can be suggested to explain heart tissue involvement: direct neighbouring extension of the tumor from a primitive mediastinal site, retrograde flow through the cardiac lymphatics and hematogenous spread.[3] In our case, retrograde lymphatics or hematogenous spread was suspected because there was no direct invasion to the epicardium The prognosis of cardiac involvement lymphoma remains poor due to diagnostic delay and advanced stage of organ infiltration However, nowadays, the addition of rituximab to the CHOP protocol increases the overall survival rate.[5] Our patient achieved complete and successful response after the Hassan Errihani, Rhizlane Belbaraka, Nabil Ismaili, Mohammed Cherti1 Department of Medical Oncology, National Institute of Oncology, Department of Cardiology, IBN SINA Hospital, Rabat, Morocco For Correspondence: Dr Rhizlane Belbaraka, Department of Medical Oncology, National Institute of Oncology, Avenue Allal Alfassi, Rabat, Morocco E-mail: r_belbaraka@yahoo.fr REFERENCES Harris NL, Jaffe ES, Stein H, Banks PM, Chan JK, Cleary ML, et al A revised European-American classification of lymphoid neoplasms: A proposal from the International Lymphoma Study Group Blood 1994;84:1361-92 Mioulet D, Braem L, Heno P, Paule P, Peloni JM, Bonnet D, et al Cardiac extension of a non-Hodgkin lymphoma revealed by an atrial flutter Ann Cardiol Angeiol (Paris) 2009;58:117-21 McDonnell PJ, Mann RB, Bulkley BH Involvement of the heart by malignant lymphoma: A clinicopathologic study Cancer 1982;49:944-51 Ban-Hoefen M, Zeglin MA, Bisognano JD Diffuse large B cell lymphoma presenting as a cardiac mass and odynophagia Cardiol J 2008;15:471-4 Morillas P, Quiles J, Nuñez D, Senent C, Martınez S, Fernañdez JA, et al Complete regression of cardiac non-Hodgkin lymphoma Int J Cardiol 2006;106:426-7 Scalp metastasis from squamous cell carcinoma of the lung performance status 3, a chest X-ray was performed The chest X-ray showed a mass lesion with spiculated borders in the left mid zone Computerized tomography of the chest revealed a mass in the left lower lobe close to the left bronchus and liver metastasis Bronchoscopy and biopsy of the lesion confirmed squamous cell carcinoma of the lung [Figure 2] Access this article online Website: www.cancerjournal.net Quick Response Code DOI: 10.4103/0973-1482.73331 PMID: *** Sir, A 60-year-old male presented to the dermatology outpatient department with two painless nodules in the scalp His physical examination was unremarkable except for the two firm swellings over the scalp and poor performance status [Figure 1] Fine needle aspiration cytology revealed atypical keratinized squamous cells arranged in clusters and singly The cells were pleomorphic, having scanty to moderate amount of cytoplasm and enlarged hyperchromatic nucleus with coarse chromatin Because the patient was a chronic smoker and 402 Cutaneous metastasis in primary lung cancer is unusual, with an incidence estimated at