Brain metastasis from myxofibrosarcoma of the heart

Abstract

The metastasis of sarcoma to the brain is very rare except for the i n v o l v e m e n t of l e u k a e m i a and l y m p h oma [1][2][3][4][5]. Cardiac m y x o f i b r o s a r c o m a is very rare and its brain metastasis is even rarer. There has been only one autopsy case report of metastatic brain m y x o f i brosarcoma from the heart [4].The authors report a case of myxofirbrosarcoma of the heart that metastasized repeatedly to the intracranial cavity. The patient was an 18-year-old female who underwent en bloc resection of a tumour in the left atrium of the heart in December, 1991. The specimen from the left atrium was a 5 • 5 • 6 cm ovoid mass with smooth surface. The cut surface was whitish yellow and partly myxoid. Microscopically, stellate or spindle cells surrounded by abundant loose stroma rich in acid mucopolysaccharides were seen. Foci of highly pleomorphic cells were present. Mitotic figures and areas of necrosis were present. The diagnosis of myxofibrosarcoma was made. She received external radiation therapy (54 Gy) and two years later underwent occipital craniotomy for the removal of an epidural mass, followed by radiotherapy (59.4 Gy). One and half years after the first craniotomy, she underwent a right suboccipital craniectomy for the removal of a right cerebellar mass (Fig. 1). Histological diagnosis of the two intracranial masses was the same as that of the cardiac mass, although the indicators of malignancy such as mitosis, cellularity, hyperchromasia, and pleomorphism were higher than those of the initial tumour. Multiple metastases to the lungs, ribs, and Vertebral bodies were noted and systemic chemotherapy with adriamycin, isophosphamide and dacarbazine was given. She lived for 50 months after the initial diagnosis and her KPS was maintained above 70 until the recurrence of the cerebellar tumour after the second craniotomy even with multiple systemic metastases.M y x o f i b r o s a r c o m a is a m a l i g n a n t t u m o u r and the final outcome is inevitably fatal [1,2], however, the *Keywords: Brain tumour; cardiac tumour; myxofibrosarcoma; metastasis.

Brain Metastasis in Bone and Soft Tissue Cancers: A Review of Incidence, Interventions, and Outcomes

“…Patients experiencing BM remain asymptomatic prior to events such as intracranial hemorrhage (ICH), which has been shown to occur [61, 67, 68]. Prognosis after detection of BM varies significantly and can be affected by the primary site, with soft tissue locations being more susceptible to multiple metastases [69]. …”

CT and MR Imaging of Primary Cardiac Malignancies

“…At gross examination, fibrosarcomas have been described as soft, lobulated, gelatinous masses (1,(69)(70)(71). At CT, low-attenuation tumor may obliterate entire chambers (72,73).…”

Primary Cardiac High-grade Myxofibrosarcoma Presenting with Multiple Brain Metastases: A Case Report

“…Few cases of cardiac myxofibrosarcomas have been reported in the literature [ 7 - 9 ]. Even if low-grade myxofibrosarcomas could recur locally, it is known that high-grade cases are associated with distant metastases, including brain metastases [ 3 , 6 , 10 ]. Nevertheless, TOE and thoracic CT/MRI scans are the gold standard to study cardiac masses, as it is extremely difficult to identify myxofibrosarcomas preoperatively [ 7 ], especially in those very atypical patients who do not express signs and symptoms of heart disease.…”

“…In case of complete or incomplete surgical resection of the primitive lesion, survival is 25 and 10 months, respectively [ 1 ]. Up to 80% of patients have evidence of metastases at the time of the initial presentation and the lung is the most common site [ 2 - 3 ]. These patients typically present with a history of dyspnea due to heart failure.…”