1
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Khong J, Abou-Hamden A, Koszyca B, Roos D, Govindaraj R. Long-term control of haemorrhagic brain metastases from atrial myxoma after radiotherapy. Br J Neurosurg 2024:1-6. [PMID: 39210545 DOI: 10.1080/02688697.2024.2395373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/17/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Cardiac myxoma is a rare, benign tumour that commonly originates in the left atrium and may lead to embolic events. Parenchymal brain metastases represent a rare neurological manifestation. While surgical intervention is commonly used, there is limited information on long-term outcomes after radiotherapy treatment. This report describes a case of successful treatment of haemorrhagic brain metastases with radiotherapy and offers a literature review of long-term results after radiotherapy treatment. CASE REPORT A 49-year-old woman presented with multiple haemorrhagic brain lesions and a cardiac mass. Surgical removal of the cardiac mass and the symptomatic brain lesion confirmed metastatic cardiac myxoma. Post-surgery, she experienced fatigued and neurocognitive impairment and was closely monitored. However, the metastases progressed. She subsequently received whole-brain radiotherapy, resulting in complete response. Seven years later, she remains in remission, although with enduring neurocognitive impairment. CONCLUSIONS Whole-brain radiotherapy can provide long-term control of haemorrhagic brain metastases arising from cardiac myxoma. Radiotherapy dose and treatment volume need careful consideration to reduce toxicity.
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Affiliation(s)
- Jeremy Khong
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Amal Abou-Hamden
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Barbara Koszyca
- SA Pathology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Daniel Roos
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Ramkumar Govindaraj
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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2
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Zhang J, Guan X, Zhang G, Yin Y, Sha Z, Zhao Y, Li J, Li B, Qiu X. Two cerebral infarctions caused by thrombus and myxomatous embolus in a patient with cardiac myxoma: A case report. Heliyon 2024; 10:e30199. [PMID: 38737257 PMCID: PMC11088245 DOI: 10.1016/j.heliyon.2024.e30199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/14/2024] Open
Abstract
An increasing number of cases of cerebral embolism caused by cardiac myxoma have been reported. However, cerebral infarction caused by different types of emboli obstructing different vascular regions within a short period of time has not been reported. This is the first report to histologically confirm cerebral infarctions independently caused by thrombus and myxomatous embolus in a patient with cardiac myxoma within a period of 23 days. The first cerebral infarction was due to embolization of thrombus to the right middle cerebral artery, whereas the second was due to embolization of tissue from a mucinous tumor to the left middle cerebral artery. Both cerebral infarctions underwent mechanical thrombectomy, but unfortunately, we ultimately failed to save the patient's life. Therefore, further attention should be paid to the surgical resection and treatment of cardiac myxoma.
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Affiliation(s)
- Ju Zhang
- Shandong Second Medical University, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
| | - Xiangfeng Guan
- Shandong Second Medical University, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
| | - Guanzhao Zhang
- Department of Cardiology, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
| | - Yingchun Yin
- Department of Pathology, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
| | - Zuowei Sha
- Department of Pathology, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
| | - Yunhe Zhao
- Department of Cardiology, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
| | - Jing Li
- Department of Pathology, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
| | - Bo Li
- Department of Cardiology, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
| | - Xueliang Qiu
- Department of Neurology, Zibo Central Hospital, NO.10, South Shanghai Road, Zibo, PR China
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3
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Choi JH, Park W, Park JC, Ahn JS. Cerebral Myxomatous Aneurysms: Case Series and Systematic Review of Literature with Adequate Follow-Up Periods and Aneurysmal Wall Biopsy Results. World Neurosurg 2023; 172:e107-e119. [PMID: 36566979 DOI: 10.1016/j.wneu.2022.12.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cerebral myxomatous aneurysms (CMA) are intracranial aneurysms caused by cardiac myxoma. The exact mechanism underlying their development has not yet been elucidated. And an optimal treatment method has not yet been established because of rarity of the disease. In addition, most existing reports have had a short follow-up period or lack of follow-up imaging test results. The aim of this study was to provide better insights into the course and treatment options of CMAs. METHODS We describe 4 CMA patients treated in our hospital and literature search was performed using PubMed and Embase databases. Keywords used were as follows: "cerebral myxomatous aneurysm", "myxomatous aneurysm", "cardiac myxoma", and "intracranial aneurysm". Only publications in English and related to this disorder with adequate follow-up periods and aneurysmal wall biopsy results were included. Clinical, radiological, pathological, and treatment characteristics were analyzed. RESULTS A total of 149 CMA cases were managed conservatively that included 9 enlargements, 6 regressions, and 134 stable aneurysms, which were identified for a total of 453.33 aneurysm years (1.91% per aneurysm year, 1.27% per aneurysm year, and 28.76% per aneurysm year, respectively). Poor outcome rate was high in cases with hemorrhage (either parenchymal or subarachnoidal hemorrhage) due to rupture of the CMA (46.67%, 7 out of 15). Thirteen cases had aneurysm biopsy results of which 11 showed tumor invasion on the aneurysm wall. CONCLUSIONS Even though the natural course of unruptured, benign-looking CMAs appears to be favorable, the presence or absence of viable tumor cells in the aneurysm may promote an unfavorable disease course. In the case of large, symptomatic, and enlarging CMAs, surgical, endovascular, or combined treatment should be considered as the mortality and morbidity due to rupture might be high.
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Affiliation(s)
- June Ho Choi
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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4
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Ma K, Zhao D, Li X, Duan H, Yan C, Wang S, Zeng L, Xu K, Lai Y, Chen B, Mu N, Yang C, Quan Y, Li Z, Wang X, Feng H, Li F. Case report: Multiple brain metastases of atrial myxoma: Clinical experience and literature review. Front Neurol 2023; 13:1046441. [PMID: 36845225 PMCID: PMC9944787 DOI: 10.3389/fneur.2022.1046441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/22/2022] [Indexed: 02/11/2023] Open
Abstract
Myxoma is the most common type of benign cardiac tumor in adults, and it has a strong tendency to embolize or metastasize to distant organs. Patients with multiple brain metastases have rarely been seen in clinics; hence, standard treatment protocols for multimyxoma metastasis in the brain have not been established. We present the case of a 47-year-old female who had convulsions in the right hand and repeated seizures. Computed tomography revealed multiple tumor sites in her brain. Craniotomy was conducted to remove the tumor sites. However, recurrent brain tumors and unexpected cerebral infarctions occurred frequently shortly after the treatment because the cardiac myxoma had not been treated due to the patient's personal concerns. The myxoma was resected by gamma knife radiosurgery, and temozolomide was given prior to cardiac surgery. There has been no evidence of tumor recurrence from the 2 years following the surgery until the present. This case highlights the importance of prioritizing cardiac lesions over cerebral lesions; if a cerebral metastasis has been found, it is likely that the cardiac myxoma is already unstable, with high rates of spread and metastasis. Therefore, it is unwise to treat metastasis sites before the cardiac myxoma. Additionally, the case suggests that gamma knife radiosurgery combined with temozolomide is effective as treatment for multiple myxoma metastasis in the brain. Compared with conventional cerebral surgery, gamma knife radiosurgery is safer, causes less bleeding, and requires a shorter time for recovery.
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Affiliation(s)
- Kang Ma
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Dawei Zhao
- Department of Neurosurgery, Chongqing Sanbo Changan Hospital, Chongqing, China
| | - Xuegang Li
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Haijun Duan
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chaojun Yan
- Department of Cardiosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shi Wang
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lan Zeng
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Kai Xu
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ying Lai
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Beike Chen
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ning Mu
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chuanyan Yang
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yulian Quan
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhengyang Li
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaoming Wang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hua Feng
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Fei Li
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China,*Correspondence: Fei Li ✉
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5
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Chojdak-Łukasiewicz J, Budrewicz S, Waliszewska-Prosół M. Cerebral Aneurysms Caused by Atrial Myxoma-A Systematic Review of the Literature. J Pers Med 2022; 13:8. [PMID: 36675669 PMCID: PMC9861364 DOI: 10.3390/jpm13010008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/11/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background: The association between cerebral aneurysms and left atrial myxoma is known but rare. We described its pathogenesis, clinical presentation, diagnostic findings and treatment using a systemic review of the literature. Methods: MEDLINE via PubMed was searched for articles published until August 2022 using the keywords "atrial myxoma", "cardiac myxoma" and "cerebral aneurysm". Results: In this review, 55 patients with multiple myxomas aneurysms were analyzed, and 65% were women. The average age when aneurysms were diagnosed was 42.5 ± 15.81; most patients were less than 60 years old (86%). Aneurysms could be found before the diagnosis, at the same time as cardiac myxoma, or even 25 years after resection of the atrial mass. In our review, the mean time to diagnoses was 4.5 years. Our review estimates that the most common symptoms were vascular incidents (25%) and seizures (14.3%). In 15 cases, variable headaches were reported. Regarding management strategies, 57% cases were managed conservatively as the primary choice. Conclusions: Although cerebral aneurysms caused by atrial myxoma are rare, the long-term consequences can be serious and patients should be monitored.
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Wang A, Wang Z, Hu K, Liu J, Cao Q, Zhang Z, Si Z. Delayed multiple intracranial aneurysms caused by left atrial myxoma: a case report and literature review. Transl Pediatr 2022; 11:149-156. [PMID: 35242661 PMCID: PMC8825931 DOI: 10.21037/tp-21-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Intracranial aneurysm may appear even after the removal of the cardiac myxoma. However, the pathogenesis and treatment of such aneurysm lesions are not clear. The study aimed to explore the clinical and imaging manifestation, hypothetical pathogenesis, and therapy in one case of left atrial myxoma causing multiple intracranial aneurysms. A 14-year-old male displayed a 3-hour history of episodic loss of consciousness and right hemiplegia after a leapfrog-like movement. The myxoma was diagnosed by a combination of clinical examination, leading to the diagnosis of mitral dynamic obstruction with a Grade III mitral diastolic murmur and tumor plop; magnetic resonance imaging, revealing multiple ischemic sites in both semi-oval centers; and transthoracic echocardiography, demonstrating a mitral valve obstruction. The myxoma was removed surgically; however, computed tomography angiography showed multiple intracranial aneurysms in both middle cerebral arteries 18 months after resection of the atrial myxoma. After conservative treatment, the patient had no neurological dysfunction symptoms for 5 years after myxoma resection. His condition is relatively stable. In conclusion, resection of the atrial myxoma may eliminate the early neurological symptoms, but it cannot ensure the nonoccurrence of delayed intracranial aneurysms. The neoplastic process theory was favored for explaining the aneurysm development in this case. According to the specific conditions of the patient, a combination of open surgery, chemotherapy, radiotherapy, and coil embolization is recommended.
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Affiliation(s)
- Aihua Wang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Zhaoxia Wang
- Department of Neurology, Juxian People's Hospital, Rizhao, China
| | - Ke Hu
- Department of Emergency Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Emergency Medicine, Jinan, China
| | - Jinzhi Liu
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Qiwei Cao
- Department of Pathology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Clinical Pathology, Shandong Lung Cancer Institute, Shandong Institute of Nephrology, Jinan, China
| | - Zixian Zhang
- Department of Neurology, Zaozhuang Municipal Hospital, Zaozhuang, China
| | - Zhihua Si
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
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7
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Yoon BH, Byun J, Kim M, Lee S, Park JC, Ahn JS, Park W. The Influence of Neurological Disorders Before Cardiac Myxoma Surgery on the Rate of Postoperative Recurrences: Analysis of 317 Patients in a Single Center. World Neurosurg 2021; 158:e128-e137. [PMID: 34710580 DOI: 10.1016/j.wneu.2021.10.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cardiac myxoma is a very rare disease for which resection is the gold standard treatment. Many neurological manifestations are associated with this disease, including embolic infarctions, arterial aneurysms, and brain metastatic myxomas, but few large-scale studies have addressed this. The aim of this study was to retrospectively analyze the incidence, type, and prognosis of these neurological disorders. METHODS We enrolled 317 patients who underwent a cardiac myxoma resection between 2004 and 2019 at our institution. A retrospective review of medical records and radiological imaging was performed for each patient, and clinical factors were compared and analyzed with regard to clinical outcomes and the incidence of adverse events. RESULTS Patients with a neurological disorder before surgery were found to be more likely to develop new postoperative neurological complications (P = 0.003). Patients with a neurological disorder arising at any time before or after surgery had poorer outcomes (P < 0.001). CONCLUSIONS The clinical management of cardiac myxoma must take account of neurological sequelae independently of the surgical intervention to remove the lesion. Patients with cardiac myxoma and any neurological disorder should undergo both neurosurgical follow-up and cardiac surgical follow-up, even if myxoma removal surgery has been performed. We recommend active neuroimaging during long-term follow-up as essential in these cases.
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Affiliation(s)
- Byul Hee Yoon
- Department of Neurosurgery, Uijeongbu Eulji Medical Center, Uijeongbu city, Gyeonggi-do, Korea
| | - Joonho Byun
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moinay Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seungjoo Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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8
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Zhang Z, Song L, Zhu X, Huang Z, Chen J, Zeng Q. Giant retroperitoneal myxoma: A case report and literature review. Int J Surg Case Rep 2021; 84:106055. [PMID: 34119939 PMCID: PMC8209073 DOI: 10.1016/j.ijscr.2021.106055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Myxoma is a benign tumor and is mesenchymal in origin. Myxomas of the retroperitoneum are extremely rare entities. CASE PRESENTATION We here report a case of a 67-year-old male who presented with progressive abdominal distention for 3 years. Laboratory investigations revealed a reduction in erythrocytes, lymphocytes, hemoglobin, and an elevation in carbohydrate antigen 19-9. Imaging findings showed a multilocular cystic mass in the right abdomen with thin septa and internal calcifications. Laparotomy revealed that the mass had arisen from the retroperitoneum and the histological study suggested the diagnosis of myxoma. DISCUSSION Myxoma features as a "cystic mass" in imaging studies. Therefore, the possibility of a cystic lymphangioma, cystic mesothelioma and myxoma should be considered when a multicystic lesion in the retroperitoneal space is observed. Due to the rarity of retroperitoneal myxomas and lack of specific manifestations and diagnostic methods, preoperative diagnosis is often delayed or incorrect. And until now, only a few cases of retroperitoneal myxoma have been reported. CONCLUSION The report will increase the understanding of the diagnosis and treatment of retroperitoneal myxomas. A brief review of the related literature was also carried out.
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Affiliation(s)
- Ziwei Zhang
- Department of Radiology,The Affiliated Hospital of Guizhou Medical university, Guiyang, China
| | - Lingling Song
- Department of Radiology,The Affiliated Hospital of Guizhou Medical university, Guiyang, China.
| | - Xia Zhu
- Department of Radiology,The Affiliated Hospital of Guizhou Medical university, Guiyang, China
| | - Zhaoshu Huang
- Department of Radiology,The Affiliated Hospital of Guizhou Medical university, Guiyang, China
| | - Jia Chen
- Department of Radiology, Guizhou Aviation Industry Corp Ltd No 300 Hospital, Guiyang, China
| | - Qi Zeng
- Department of Radiology,The Affiliated Hospital of Guizhou Medical university, Guiyang, China
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9
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Targeted Radiation Therapy Can Treat Myxomatous Cerebral Aneurysms. World Neurosurg 2020; 143:332-335. [DOI: 10.1016/j.wneu.2020.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 01/12/2023]
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10
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Aguilar C, Carbajal T, Beltran BE, Segura P, Muhammad S, Choque-Velasquez J. Cerebral embolization associated with parenchymal seeding of the left atrial myxoma: Potential role of interleukin-6 and matrix metalloproteinases. Neuropathology 2020; 41:49-57. [PMID: 32776398 DOI: 10.1111/neup.12697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/06/2020] [Accepted: 06/12/2020] [Indexed: 12/28/2022]
Abstract
Systemic embolization has been reported in up to 40% of patients with left atrial myxoma, half of them with cerebral involvement. However, development of intracerebral embolization associated with parenchymal seeding of the myxoma emboli is an extremely rare complication, with only 36 histologically diagnosed cases reported in the published literature. We describe a 69-year-old woman who arrived at the emergency service with hemiparesis associated with drug-resistant epilepsy and a medical history of resection of a left atrial myxoma 10 months previously. Cranial computed tomography revealed multiple large lesions of heterogeneous density and cystic components in the occipital lobes and posterior fossa parenchyma. Histopathological analyses after stereotactic biopsy of the occipital lesion revealed infiltrative myxoma cells with benign histological findings and uniform expression of calretinin similar to that of the primary cardiac myxoma. Additional immunohistochemical studies confirmed brain parenchymal seeding of the myxoma cells with strong expression of interleukin-6 (IL-6) and focal expression of matrix metalloproteinases-2 (MMP-2). Here, we discuss the clinicopathological features of intracerebral embolization of left atrial myxomas associated with progressive parenchymal seeding of the tumor emboli and the potential pathogenic role of IL-6 and MMPs.
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Affiliation(s)
- Cristian Aguilar
- Department of Pathology, Edgardo Rebagliati Martins National Hospital, Lima, Peru.,Laboratory of Pathology, National Cardiovascular Institute, Lima, Peru
| | - Tomas Carbajal
- Department of Pathology, Edgardo Rebagliati Martins National Hospital, Lima, Peru
| | - Brady E Beltran
- Department of Radiation Oncology, Edgardo Rebagliati Martins National Hospital, Lima, Peru
| | - Pedro Segura
- Department of Cardiology, Edgardo Rebagliati Martins National Hospital, Lima, Peru
| | - Sajjad Muhammad
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.,Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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11
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Mbadugha TN, Kanaya K, Horiuchi T, Iwaya M, Ohaegbulam SC, Hongo K. Primary myxoid temporal bone tumor: A rare neurosurgical manifestation of Carney complex? Surg Neurol Int 2020; 11:166. [PMID: 32637219 PMCID: PMC7332703 DOI: 10.25259/sni_170_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/09/2020] [Indexed: 02/04/2023] Open
Abstract
Background: Carney complex (CNC) is a rare autosomal dominant syndrome, manifesting mainly with cardiac, cutaneous, and mucosal myxomas. Osteochondromyxoma is known as an extremely rare bone lesion of CNC which usually appears early in life; however, there were no reports of primary bone myxoma of the skull in the patients with CNC. We present the first case of primary myxoid skull tumor in the patient with CNC. Case Description: We report the left temporal bone tumor with significant intracranial mass effect in a 58-year- old woman already diagnosed with CNC. Complete resection of the tumor with skull bone reconstruction was carried out. Pathological diagnosis was labeled the lesion as an atypical myxoid spindle cell neoplasm. The features were different from atrial myxoma and osteochondromyxoma which has been described in CNC. There have been no signs of recurrence in 9 years follow-up. Conclusion: To the best of our knowledge, there have been no reports of the primary myxoid tumors in the skull in the patients with CNC. This paper highlighted a possible important association between CNC and primary intracranial myxoid tumors.
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Affiliation(s)
- Tobechi Nwankwo Mbadugha
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Onitsha Expressway, Enugu, Nigeria
| | - Kohei Kanaya
- Department of Neurosurgery, Shinshu University School of Medicine, Asahi, Matsumoto, Nagano, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Asahi, Matsumoto, Nagano, Japan
| | - Mai Iwaya
- Department of Laboratory Medicine, Shinshu University School of Medicine, Asahi, Matsumoto, Nagano, Japan
| | | | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Asahi, Matsumoto, Nagano, Japan
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12
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Waikar HD, Jayakrishnan AG, Bandusena BSN, Priyadarshan P, Kamalaneson PP, Ileperuma A, Neema PK, Dhawan R, Chaney MA. Left Atrial Myxoma Presenting as Cerebral Embolism. J Cardiothorac Vasc Anesth 2020; 34:3452-3461. [PMID: 32773155 DOI: 10.1053/j.jvca.2020.06.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/31/2022]
Affiliation(s)
| | | | | | | | | | | | - Praveen Kumar Neema
- Department of Anaesthesiology, All India Institute of Medical Sciences, Raipur, India
| | - Richa Dhawan
- Department of Anesthesia and Critical Care, University of Chicago Hospitals, Chicago, IL
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago Hospitals, Chicago, IL
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13
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Maas JA, Menes M, Siomin V. Cardiac Myxoma with Cerebral Metastases and Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: A Case Report and Review. J Neurol Surg Rep 2020; 81:e1-e6. [PMID: 32051810 PMCID: PMC7012640 DOI: 10.1055/s-0039-3399570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 09/28/2019] [Indexed: 12/20/2022] Open
Abstract
Background
Cardiac myxomas, the most common primary cardiac tumors, are generally benign neoplasms. Primary cardiac lymphoma is a rare cardiac malignancy with a very poor prognosis. Here we present a case of a cardiac myxoma with cerebral metastases and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) arising within the cerebral metastases.
Case description
A 62-year-old man, who presented with symptoms of multiple transient ischemic attacks, was found to have a left atrial myxoma. Twelve months after excision of the myxoma, the patient experienced a recurrence of neurologic symptoms. Brain magnetic resonance imaging revealed multiple hemorrhagic masses. Craniotomy was performed to resect the lesions. Histopathologic examination confirmed cardiac myxoma metastases and a small lymphocytic infiltrate within the tumor consistent with CLL/SLL.
Conclusion
Including the present case, there are 27 cases of cardiac myxoma cerebral metastases and 22 cases of lymphomas arising within myxomas. The present case is the first known instance of both entities in the same patient. There is no standard management for either cardiac myxoma metastases or lymphoma within a myxoma. For both diseases, surgical excision is the primary treatment modality, but postoperative chemotherapy and/or radiation have been attempted. Myxomas may create a chronic inflammatory state that could lead to the development of CLL/SLL.
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Affiliation(s)
- Jared A Maas
- Department of Radiation Oncology, University of Alabama at Birmingham, Hazelrig Salter Radiation Oncology Center, Birmingham, Alabama, United States
| | - Manuel Menes
- Department of Pathology, Baptist Health South Florida, Miami, Florida, United States
| | - Vitaly Siomin
- Department of Neurosurgery, Baptist Health South Florida, Miami, Florida, United States
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Panos LD, Brunel C, Berezowska S, Engisch R, Kollar A, Bassetti C, Sturzenegger M, Krestel H. Early and delayed neurological manifestations of cardiac myxomas. Clin Neurol Neurosurg 2020; 190:105673. [PMID: 31945622 DOI: 10.1016/j.clineuro.2020.105673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/27/2019] [Accepted: 01/05/2020] [Indexed: 10/25/2022]
Abstract
Cardiac myxoma can embolize and cause early and delayed sequelae including stroke, growth into intracranial fusiform aneurysms and cerebral tumors with risk of hemorrhage and mass effect. Here, we report the rare coincidence of all these manifestations in a 63-year-old man who presented with cognitive and behavioral changes, and seizures 9 months after an embolic stroke from the heart tumor. C-reactive protein (CRP) was elevated at the time of stroke and cardiac myxoma diagnosis but was normal at late neurologic manifestation with isolated myxoma-related intracranial tumors and aneurysms. Low-dose whole-brain radiotherapy can be helpful to diminish cerebral myxoma tumors and fusiform aneurysms despite reported increased risk of aneurysm rupture.
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Affiliation(s)
- Leonidas D Panos
- Departments of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Bern, Switzerland.
| | - Christophe Brunel
- Institute of Pathology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | | | - Renate Engisch
- Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Attila Kollar
- Departments of Oncology, Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Claudio Bassetti
- Departments of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Mathias Sturzenegger
- Departments of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Heinz Krestel
- Departments of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Bern, Switzerland.
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Somatic PRKAR1A mutation in sporadic atrial myxoma with cerebral parenchymal metastases: a case report. J Med Case Rep 2019; 13:389. [PMID: 31874650 PMCID: PMC6930684 DOI: 10.1186/s13256-019-2317-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/18/2019] [Indexed: 11/25/2022] Open
Abstract
Background Atrial myxomas are generally considered benign neoplasms. The majority of tumors are sporadic and less than 10% are associated with an autosomal dominant condition known as the Carney complex, which is most often caused by germline mutation in the gene PRKAR1A. Whether this gene plays a role in the development of sporadic myxomas has been an area of debate, although recent studies have suggested that some fraction of sporadic tumors also carry mutations in PRKARIA. Extra-cardiac complications of atrial myxoma include dissemination of tumor to the brain; however, the dissemination of viable invasive tumor cells is exceedingly rare. Case presentation We present here a 48-year-old white woman who developed multiple intracranial hemorrhagic lesions secondary to tumor embolism that progressed to ‘false’ aneurysm formation and invasion through the vascular wall into brain parenchyma 7 months after resection of an atrial myxoma. Whole exome sequencing of her tumor revealed multiple mutations in PRKAR1A not found in her germline deoxyribonucleic acid (DNA), suggesting that the myxoma in this patient was sporadic. Conclusions Our patient illustrates that mutations in PRKAR1A may be found in sporadic lesions. Whether the presence of this mutation affects the clinical behavior of sporadic tumors and increases risk for metastasis is not clear. Regardless, the protein kinase A pathway which is regulated by PRKAR1A represents a possible target for treatment in patients with metastatic cardiac myxomas harboring mutations in the PRKARIA gene.
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Penn DL, Lanpher AB, Klein JM, Kozakewich HPW, Kahle KT, Smith ER, Orbach DB. Multimodal treatment approach in a patient with multiple intracranial myxomatous aneurysms. J Neurosurg Pediatr 2018; 21:315-321. [PMID: 29303459 DOI: 10.3171/2017.9.peds17288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The most common primary cardiac tumor is myxoma, typically originating in the left atrium. Emboli to the central nervous system can cause cerebral infarction or, rarely, seed tumor growth within vessel walls, causing myxomatous aneurysms. Fewer than 60 myxomatous aneurysms have been reported, including 2 cases in children. Here, the authors describe 2 different growing myxomatous aneurysms in a child successfully managed using a combined multidisciplinary approach. A 12-year-old boy developed a sudden headache, diplopia, gait instability, and speech difficulty. Magnetic resonance imaging revealed a left parietal hemorrhage and multifocal cerebral infarction, suspicious for an embolic etiology. A cardiac myxoma was identified in the left atrium and resected. Follow-up cranial vasculature imaging demonstrated multiple intracranial myxomatous aneurysms. These lesions were followed up, and serial imaging identified marked growth of 2 of them (right occipital and left parietal), prompting invasive intervention. The deep occipital lesion was better suited to endovascular treatment, while the superficial parietal lesion was amenable to resection. The patient underwent embolization of an enlarging fusiform aneurysm of the distal right posterior cerebral artery, followed by a left parietal craniotomy for a lesion of the distal left middle cerebral artery. Both procedures were performed without complications and achieved successful obliteration of the lesions, as confirmed by catheter angiography at the 30-month follow-up. To the authors' knowledge, this report illustrates the first combined endovascular and open surgical treatment of 2 myxomatous aneurysms in a single patient. While acknowledging the rarity of this condition, this report illustrates the clinical manifestations and treatment challenges posed by myxoma and details a successful strategy that could be employed in similar scenarios.
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Affiliation(s)
| | | | | | | | - Kristopher T Kahle
- Departments of3Neurosurgery.,5Pediatrics, and.,6Cellular and Molecular Physiology, Yale University, New Haven, Connecticut
| | | | - Darren B Orbach
- 4Radiology, Boston Children's Hospital, Boston, Massachusetts; and
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Rose D, Papa A, Tomao S, Greco E, Zacharias J. Cerebral Metastases in Patients with Left Atrial Myxoma. J Card Surg 2016; 31:289-93. [DOI: 10.1111/jocs.12727] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- David Rose
- Department of Cardiothoracic Surgery, Lancashire Cardiac Center; Blackpool Victoria Hospital; Lancashire England
| | - Anselmo Papa
- Oncology Unit-Department of Medico-Surgical Sciences and Biotechnologies; “Sapienza” University of Rome, ICOT; Latina Italy
| | - Silverio Tomao
- Oncology Unit-Department of Medico-Surgical Sciences and Biotechnologies; “Sapienza” University of Rome, ICOT; Latina Italy
| | - Ernesto Greco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences; Policlinico Umberto I-Sapienza University of Rome; Rome Italy
| | - Joseph Zacharias
- Department of Cardiothoracic Surgery, Lancashire Cardiac Center; Blackpool Victoria Hospital; Lancashire England
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Sato T, Saji N, Kobayashi K, Shibazaki K, Kimura K. [A case of cerebral embolism due to cardiac myxoma presenting with multiple cerebral microaneurysms detected on first MRI scans]. Rinsho Shinkeigaku 2016; 56:98-103. [PMID: 26797485 DOI: 10.5692/clinicalneurol.cn-000821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 64-year-old man developed right arm weakness and dysarthria, and was admitted to our hospital. Diffusion-weighted magnetic resonance imaging of the brain showed a high intensity area in the frontal lobe. T2*-weighted images showed multiple spotty low intensity lesions in bilateral cerebral hemispheres, mimicking cerebral microbleeds. Cerebral angiography showed multiple aneurysms in the anterior, middle, posterior cerebral arteries and cerebellar arteries. Transthoracic echocardiography revealed a floating structure in the left atrial chamber, indicating cardiac myxoma. We diagnosed cardioembolic ischemic stroke due to left atrial myxoma. Cardiac surgery for excision of a left atrial myxoma was performed on the 3rd hospital day. Multiple aneurysms should be taken into account for differential diagnosis in patients with cardiac myxoma and with atypical spotty low intensity on T2*-weighted images.
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Affiliation(s)
- Takahiro Sato
- Department of Stroke Medicine, Kawasaki Medical School
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Rokadia HK, Heresi GA, Tan CD, Raymond DP, Budd GT, Farver C. A 33-year-old man with multiple bilateral pulmonary pseudoaneurysms. Chest 2016; 148:e112-e117. [PMID: 26437818 DOI: 10.1378/chest.15-0624] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
A 33-year-old man, never smoker, presented with acute-onset dyspnea secondary to bilateral pulmonary emboli. Echocardiography at the time revealed a right atrial myxoma, for which he underwent resection, followed by anticipated lifelong therapeutic anticoagulation therapy.
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Affiliation(s)
| | | | - Carmela D Tan
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland OH
| | - Daniel P Raymond
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland OH
| | | | - Carol Farver
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland OH
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20
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Gupta MM, Agrawal N. Oncotic Cerebral Aneurysms in a Case of Left Atrial Myxoma, Role of Imaging in Diagnostics and Treatment. Pol J Radiol 2015; 80:490-5. [PMID: 26600878 PMCID: PMC4634163 DOI: 10.12659/pjr.894977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 07/10/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Myxomatous cerebral (oncotic) aneurysms following atrial myxoma is a rare neurological complication. CASE REPORT We report an 11-year- old boy with left atrial myxoma and multiple cerebral oncotic aneurysms. The characteristics of these aneurysms are indefinite and variable. The "Metastasize and Infiltrate" theory may be the key mechanism in the formation of these aneurysms. CONCLUSIONS Magnetic resonance imaging (MRI), computed tomography (CT) and angiography are useful in the diagnostics while digital subtraction angiography (DSA) is the best option. There are no definite guidelines for therapy of these aneurysms. Resection of cardiac myxomas, chemotherapy, radiotherapy, coil embolization and surgical treatment could be helpful.
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Affiliation(s)
- Madan Mohan Gupta
- Department of Interventional Neuroradiology, Jaslok Hospital and Research Center, Mumbai, India
| | - Neha Agrawal
- Department of Critical Care Medicine, Jaslok Hospital and Research Center, Mumbai, India
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21
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Cerebral Metastasis Presenting after Complete Primary Resection of Atrial Myxoma: Case Report. Can J Neurol Sci 2015; 42:457-60. [DOI: 10.1017/cjn.2015.293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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22
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Sveinsson O, Herrman L. Multiple cerebral aneurysms in a patient with cardiac myxoma: what to do? BMJ Case Rep 2015; 2015:bcr-2013-200767. [PMID: 25673094 DOI: 10.1136/bcr-2013-200767] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cardiac myxomas are a very uncommon cause of cerebral aneurysms. We present a case of a young woman with neurological symptoms attributed to small cortical infarctions and multiple cerebral aneurysms, caused by a cardiac myxoma.
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Affiliation(s)
- Olafur Sveinsson
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Herrman
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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23
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Etoposide/carboplatin chemotherapy for the treatment of metastatic myxomatous cerebral aneurysms. J Neurol 2014; 261:828-30. [DOI: 10.1007/s00415-014-7281-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 02/08/2014] [Indexed: 10/25/2022]
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Xu Q, Zhang X, Wu P, Wang M, Zhou Y, Feng Y. Multiple intracranial aneurysms followed left atrial myxoma: case report and literature review. J Thorac Dis 2014; 5:E227-31. [PMID: 24416521 DOI: 10.3978/j.issn.2072-1439.2013.11.27] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 11/11/2013] [Indexed: 12/26/2022]
Abstract
Cerebral aneurysms follows atrial myxoma is a rare neurological complication. We report a patient with multiple cerebral aneurysms three years after resection of left atrial myxoma and further review the literature. The characteristics of these aneurysms are indefinite and variable. They can occur prior or post the resection of cardiac myxoma. "Metastasize and Infiltrate" theory may be the key mechanism in the formation of these aneurysms. Magnetic resonance imaging (MRI), computed tomography (CT) and angiography are useful in the diagnosis while digital subtraction angiography (DSA) is the best choice. There are no definite guidelines for therapy of these aneurysms. Resection of the cardiac myxomas, chemotherapy, radiotherapy, coil embolization and surgical treatment could be helpful.
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Affiliation(s)
- Qingsheng Xu
- Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, P.R. China
| | - Xiaobing Zhang
- Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, P.R. China
| | - Pan Wu
- Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, P.R. China
| | - Ming Wang
- Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, P.R. China
| | - Yongqing Zhou
- Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, P.R. China
| | - Yiping Feng
- Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, P.R. China
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Smith M, Chaudhry MA, Lozano P, Humphrey MB. Cardiac myxoma induced paraneoplastic syndromes: a review of the literature. Eur J Intern Med 2012; 23:669-73. [PMID: 23122392 DOI: 10.1016/j.ejim.2012.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 04/13/2012] [Accepted: 05/28/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Atrial myxomas are the most common benign tumors of the heart and may present with a wide variety of symptoms. Although 45% of patients present with neurological symptoms, a diverse range of systemic symptoms also occur. METHODS A systemic review of the literature related to the diagnosis, treatment, pathogenesis, and symptoms associated with atrial myxomas was performed. RESULTS Here we summarize the current state of understanding about myxoma pathogenesis and treatments are described. We review the common and rare local and systemic effects of myxomas. Additionally, we review the paraneoplastic and metastatic potential of myxomas. CONCLUSIONS A better understanding of the diverse disease presentations, paraneoplastic syndromes, and side effects of cytokine abnormalities stemming from myxomas will aid the physician in earlier detection and monitoring of disease recurrence.
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Affiliation(s)
- Marcus Smith
- Department of Internal Medicine, Section of Cardiovascular Disease, University of Oklahoma Health Sciences Center, Oklahoma City 73104, USA.
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Raza E, Kamal AK. Recurrent non-aneurysmal, metastatic intraparenchymal haemorrhages following resection of atrial myxoma - case report and literature review. BMJ Case Rep 2012; 2012:bcr.02.2012.5772. [PMID: 23104629 DOI: 10.1136/bcr.02.2012.5772] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Atrial myxomas are the commonest cardiac neoplasms. The most common extra-cardiac manifestations are embolic infarcts from tumour embolisation. Infrequently, aneurysm formation and intracranial haemorrhages also occur. Incredibly rare are space-occupying lesions and malignant transformation. The authors report a case of a previously healthy middle-aged lady who developed recurrent and expanding intraparenchymal haemorrhages following resection of a left atrial myxoma without any primary disease recurrence. The case described is completely different from the described literature in that her intracranial vasculature was free of aneurysms on angiography despite central nervous system haemorrhage and no myxomatous or malignant features were seen on histology of the resected symptomatic occipital lesion. The authors compare this case to the available literature and also provide a literature review.
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Affiliation(s)
- Emmon Raza
- Neurology Department, Stroke Service, Aga Khan University, Karachi, Pakistan
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28
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Lee SJ, Kim JH, Na CY, Oh SS. Eleven years' experience with Korean cardiac myxoma patients: focus on embolic complications. Cerebrovasc Dis 2012; 33:471-9. [PMID: 22517375 DOI: 10.1159/000335830] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 12/12/2011] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Cardiac myxomas are rare but are the most common cardiac tumors. This study is based on our clinical experience with cardiac myxomas over a period of 11 years at Sejong General Hospital. We focused on the embolic complications of patients with cardiac myxoma. METHODS We retrospectively reviewed the medical records of 59 consecutive patients with cardiac myxoma who were treated between January 2000 and March 2011. The myxomas were divided into two types: type 1, with an irregular or villous surface and a soft consistency, and type 2, with a smooth surface and a compact consistency. The 59 investigated patients were classified into the embolic group and the non-embolic group. RESULTS Cardiac obstructive symptoms, embolic events and constitutional symptoms were observed in 37 (62.7%), 13 (22.0%) and 10 (16.9%) patients, respectively. When the embolic and non-embolic groups were compared, there were no significant differences in vascular risk factors, the ejection fraction, the left atrial diameter or the tumor size. However, type 1 myxomas were significantly more frequent in the embolic group (p = 0.009 by Fisher's exact test). A binary logistic regression analysis showed that type 1 pathology alone was independently associated with myxoma-related embolism (p = 0.008; odds ratio 10.056; 95% confidence interval 1.828-55.337). There were no operative deaths in any of the 59 patients studied. Among the 13 patients with embolism, 11 (84.6%) had brain infarcts. The main patterns of the lesions were multiple lesions (8 out of 11 patients, 72.7%) and lesions in the middle cerebral artery territories (7 out of 11 patients, 63.6%). The other 2 patients were found to have occlusion of the left central retinal artery and left external iliac artery. Additionally, incidental cerebral aneurysms were found in the latter case. There was no recurrence of myxoma or myxoma-related symptoms in the 53 patients receiving outpatient management during the follow-up period (range 2 months to 11 years). CONCLUSIONS The embolic potential of myxoma was associated with an irregular surface pathology but not with vascular risk factors. Echocardiography should be performed in patients with embolic events, especially when cerebral infarcts with multiple territorial lesions are detected. Surgical resection is a relatively safe and curative procedure for cardiac myxoma.
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Affiliation(s)
- Seung-Jae Lee
- Department of Neurology, Sejong General Hospital, Bucheon, Republic of Korea.
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Abstract
A 45-year-old lady presented with transient ischemic attack symptoms. Subsequent CT and DSA revealed multiple fusiform dilatations of cerebral vessels. A search for sources of emboli led to an atrial myxoma being found on echocardiogram. She made a good recovery after resection of the atrial myxoma. The aneurysms were managed conservatively. We discuss the association of multiple cerebral aneurysms with atrial myxoma.
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De Marco A, La Tessa G, De Falco A, De Falco F, Merola A, Sirabella G. Multiple Cerebral Aneurysms Associated with Atrial Myxoma. Neuroradiol J 2010; 23:62-8. [DOI: 10.1177/197140091002300111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 09/27/2009] [Indexed: 11/16/2022] Open
Abstract
Cardiac myxoma is a tumor of mesenchymal origin accounting for half of all primary cardiac neoplasms. Intracranial involvement by atrial myxoma is a rare cause of neurologic deficit. When the myxoma arises in the left atrium, systemic emboli from a cardiac myxoma can lead to infarction, cerebral hemorrhage and aneurysm formation. In the light of the potentially preventable nature of these lesions, the diagnosis of myxomatous aneurysms should be considered in any patient with neurologic symptoms and a history of cardiac myxoma. Because aneurysms are often stable over several years, conservative management with careful clinical and radiological follow-up with MRI and angiography seems sensible. We describe a case in which MR imaging and angiography were used to diagnose multiple cerebral aneurysms caused by left atrial myxoma.
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Affiliation(s)
- A. De Marco
- Department of Neuroradiology, Santa Maria di Loreto Nuovo Hospital; Naples, Italy
| | - G. La Tessa
- Department of Neuroradiology, Santa Maria di Loreto Nuovo Hospital; Naples, Italy
| | - A. De Falco
- Department of Neurology, Santa Maria di Loreto Nuovo Hospital; Naples, Italy
| | - F.A. De Falco
- Department of Neurology, Santa Maria di Loreto Nuovo Hospital; Naples, Italy
| | - A. Merola
- Department of Neuroradiology, Santa Maria di Loreto Nuovo Hospital; Naples, Italy
| | - G. Sirabella
- Department of Neuroradiology, Santa Maria di Loreto Nuovo Hospital; Naples, Italy
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Ryou KS, Lee SH, Park SH, Park J, Hwang SK, Hamm IS. Multiple fusiform myxomatous cerebral aneurysms in a patient with Carney complex. J Neurosurg 2008; 109:318-20. [DOI: 10.3171/jns/2008/109/8/0318] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Carney complex is a rare autosomal-dominant familial tumor syndrome that involves the triad of myxoma, mucocutaneous pigmentation, and endocrine overactivity. To the best of the authors' knowledge, there are no reports of multiple fusiform aneurysms coinciding with atrial myxoma.
The authors report the case of a 38-year-old woman with typical Carney complex who had multiple skin myxomas, endocrine abnormalities, and multiple brownish perioral lesions. Multiple fusiform aneurysms were also discovered after the recurrence of atrial myxoma. During a follow-up period of > 10 years, there have been no angiographic changes in the aneurysms and no progression of symptoms.
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Moiyadi AV, Moiyadi AA, Sampath S, Kalpana SR, Mahadevan A, Shankar SK, Srikanth SG. Intracranial metastasis from a glandular variant of atrial myxoma. Acta Neurochir (Wien) 2007; 149:1157-62. [PMID: 17906966 DOI: 10.1007/s00701-007-1291-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Accepted: 06/12/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intracranial metastases from atrial myxoma producing symptomatic mass lesions are very rare with only ten examples reported in the literature. We report a patient with multiple metastases from a cardiac myxoma which had an unusual histopathology mimicking an adenocarcinoma. CLINICAL PRESENTATION A 35 year old man presented with left facio-brachial focal motor seizures unresponsive to antiepileptic drugs and these episodes preceded the symptoms of cardiac myxoma. The seizures worsened a year following resection of the cardiac myxoma. The MRI of the brain revealed multiple lesions of heterogeneous intensity, partly solid and cystic situated in the right fronto-parietal, left temporal and occipital lobes. FINDINGS Right fronto-parietal craniotomy revealed lesions with haemorrhagic, calcified areas and a large cystic component was decompressed. Histological examination of the lesions in the brain demonstrated prominent glandular differentiation, identical in morphology to the primary cardiac lesion of a glandular variant of atrial myxoma. CONCLUSION This report highlights the rare presentation of atrial myxoma with intracranial metastases and reviews previously reported examples. This is only the second case report of a glandular variant of atrial myxoma with metastases to the brain. A pathologist, unaware of this unusual variant of primary atrial myxoma, may mistake the intracranial lesion for a metastatic adenocarcinoma.
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Affiliation(s)
- A V Moiyadi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.
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Sedat J, Chau Y, Dunac A, Gomez N, Suissa L, Mahagne MH. Multiple cerebral aneurysms caused by cardiac myxoma. A case report and present state of knowledge. Interv Neuroradiol 2007; 13:179-84. [PMID: 20566147 DOI: 10.1177/159101990701300209] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Accepted: 04/30/2007] [Indexed: 12/13/2022] Open
Abstract
SUMMARY A case of multiple cerebral aneurysms caused by left atrial myxoma is reported.We present the details of this case and discuss the hypothetical pathogenesis, radiological aspects and treatment of these neoplastic aneurysms.
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Affiliation(s)
- J Sedat
- Unité de Neuroradiologie Interventionnelle CHU Nice, France -
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Stainback RF, Hamirani YS, Cooley DA, Buja LM. Tumors of the Heart. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Altundag MB, Ertas G, Ucer AR, Durmus S, Abanuz H, Calikoğlu T, Ozbagi K, Demirkasimoglu A, Kaya B, Bakkal BH, Altundag K. Brain Metastasis of Cardiac Myxoma: Case Report and Review of the Literature. J Neurooncol 2005; 75:181-4. [PMID: 16132507 DOI: 10.1007/s11060-005-1859-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cardiac myxoma is the most common benign heart tumor. Cardiac myxoma can be a sporadic lesion (93% of cases) and usually occurs in women over 30 years. Complete surgical removal of the myxoma and its cardiac attachment is usually curative. The frequency of recurrences in cardiac myxomas varies between 3% for sporadic cases and 22% for cases of Carney complex. Recurrence has been related to incomplete excision, multifocality, and embolism of tumor fragments. We report a case with multiple brain metastases presumably due to tumor embolization from previously operated cardiac myxoma.
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Sabolek M, Bachus-Banaschak K, Bachus R, Arnold G, Storch A. Multiple cerebral aneurysms as delayed complication of left cardiac myxoma: a case report and review. Acta Neurol Scand 2005; 111:345-50. [PMID: 15876333 DOI: 10.1111/j.1600-0404.2005.00413.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Left cardiac myxoma and also consecutive embolization into the brain is well documented, whereas the association of myxomas with multiple fusiform cerebral aneurysms is rare. We analyze 33 previously reported patients and present a case of a 43-year-old woman with multiple cerebral infarctions 2 years after resection of a recurrent myxoma in the left atrium. Cerebral angiography displayed multiple fusiform aneurysms of several cerebral arteries, including a giant aneurysm of the basilar artery. Serum level of interleukin-6 (IL-6) was highly elevated. The clinical, radiological and pathological features of these aneurysms are summarized. The pathogenesis, including the role of IL-6 in the formation of myxomatous aneurysms, is discussed.
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Affiliation(s)
- M Sabolek
- Department of Neurology, University of Ulm, Ulm, Germany
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Ipek G, Erentug V, Bozbuga N, Polat A, Guler M, Kirali K, Peker O, Balkanay M, Akinci E, Alp M, Yakut C. Surgical Management of Cardiac Myxoma. J Card Surg 2005; 20:300-4. [PMID: 15854102 DOI: 10.1111/j.1540-8191.2005.200415.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Between 1994 and December 2003, 55 patients were operated for cardiac myxoma in Kosuyolu Heart and Research Hospital in Istanbul. METHODS We retrospectively analyzed our results according to the preoperative characteristics, operative procedures, and postoperative courses. RESULTS Of 55 patients operated, 36 (65.4%) were female and 19 (34.6%) male. The average age of the patients was 48 +/- 15.5 years (range, 12-75). Thirteen patients (23.6%) previously had cerebrovascular accidents. Peripheral arterial emboli had occurred in 11 (20%) patients. The majority of the patients (44.4%) were in NYHA Class II preoperatively. One patient was presented with Carney's complex. Most frequent location was the left atrium (85.2%). Eight patients had concommitant surgery together with myxoma extirpation. Postoperative courses were uneventful. Three patients had a new onset atrial fibrillation, two had transient conduction disturbances. There were two (3.6%) in-hospital deaths. No recurrences have been noted during the 82.4 +/- 40.6 months (a total of 315.75 patient/years) follow-up. CONCLUSIONS Surgical management of cardiac myxoma gives excellent results. In selected cases, a conservative approach may be adequate. Despite the scarcity of the neoplastic properties, careful follow-up is necessary.
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Affiliation(s)
- Gokhan Ipek
- Koşuyolu Heart and Research Hospital, Istanbul, Turkey
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