Early and delayed neurological manifestations of cardiac myxomas

Panos, Leonidas; Brunel, Christophe; Berezowska, Sabina; Engisch, Renate; Kollár, Attila; Bassetti, Claudio; Sturzenegger, Mathias; Krestel, Heinz

doi:10.1016/j.clineuro.2020.105673

Cited by 6 publications

(8 citation statements)

References 17 publications

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“…Although the mechanisms of embolization of a benign tumor and metastasis of an invasive malignancy are fundamentally different, the appearance of multiple lesions at a distant site in the setting of a cardiac myxoma has occasionally been referred to (erroneously) in the literature as “metastasis.” 17,18 Since the first description made by Rankin et al ., in 1978, 19 our comprehensive review revealed 36 histologically established cases of intracerebral embolization associated with parenchymal brain invasion from a benign left atrial myxoma (Table 1). 10,14,18–51 A careful review of the cases confirmed that three patients have been reported twice, 14,19,20,23,24,28 six patients had unavailable histological proof, 37,52–56 and four apparent primary cardiac sarcomas were erroneously reported as a cardiac myxoma 57–60 . In one case, the original report could not be located, 61 and another report described embolic myxoma cells in the leptomeninges without evidence of parenchymal seeding 62 …”

Section: Discussionmentioning

confidence: 96%

“…Radiotherapy has been frequently conducted for patients with multiple or progressive lesions, with promising results, although clinical follow up managements are limited. 10,32,38,45,47,49,51 Considering that these lesions have persistently active tumor cells, adjuvant chemotherapy would be a reliable option to reduce the risk of extracardiac seeding. However, no previous information on experiences in the management of this therapeutic option in cardiac myxomas is available.…”

Section: Discussionmentioning

confidence: 99%

“…In our review, similar to the primary cardiac tumor, surgery was the most frequent therapeutic option in patients with accessible brain lesions. Radiotherapy has been frequently conducted for patients with multiple or progressive lesions, with promising results, although clinical follow up managements are limited 10,32,38,45,47,49,51 . Considering that these lesions have persistently active tumor cells, adjuvant chemotherapy would be a reliable option to reduce the risk of extracardiac seeding.…”

Section: Discussionmentioning

confidence: 99%

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Cerebral embolization associated with parenchymal seeding of the left atrial myxoma: Potential role of interleukin‐6 and matrix metalloproteinases

et al. 2020

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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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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cerebral embolization associated with parenchymal seeding of the left atrial myxoma: Potential role of interleukin‐6 and matrix metalloproteinases

et al. 2020

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“…Intracerebral hemorrhage including parenchymal hematoma and subarachnoid hemorrhage (SAH) is less common in myxoma patients but usually leads to a much worse outcome than cerebral embolism. Rupture of myxomatous aneurysm is thought to be the major cause for both parenchymal hematoma and SAH associated with cardiac myxoma [5][6][7][8][9]. Myxoma complicated by SAH, with the absence of a myxomatous intracerebral aneurysm, is not reported.…”

Section: Introductionmentioning

confidence: 99%

Subarachnoid Hemorrhage Following Ischemic Stroke Caused by Atrial Myxoma

Chen¹,

Xu²,

Zhuang³

et al. 2021

Cureus

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Subarachnoid hemorrhage (SAH) is a rare neurological complication of cardiac myxoma and is associated with poor outcomes. Previous reports have shown that myxoma-associated SAH was contributed by rupture of myxomatous intracerebral aneurysm. Here, we present an unusual case of angiographic-negative SAH in a young patient with left atrial myxoma. A 28-year-old male was admitted for SAH. He had a history of magnetic resonance imaging (MRI)-confirmed ischemic stroke one year ago. The digital subtraction angiography (DSA) performed on next day revealed no intracerebral aneurysm or vascular malformation. Transthoracic echocardiography (TTE) showed a left atrial mass measuring 5.09 * 3.34 cm, indicating a diagnosis of atrial myxoma, which was confirmed by pathological examination. The cardiac tumor was excised and the patient’s symptoms improved completely. No intracerebral aneurysm was found by brain computed tomographic angiography (CTA) performed on day 24 after onset and one year after discharge. The patient remained asymptomatic during the one-year following-up. The result suggests that SAH may be more commonly associated with cardiac myxoma than previously expected. And, mechanisms other than rupture of myxomatous intracerebral aneurysm involve in SAH associated with cardiac myxoma. Prolonged length of following-up using novel imaging technique should be applied to identify and monitor the change of source bleeding.

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“…It is known that cardiac myxomas are presented with high histopathologic eterogenity and the investigation of the inflammatory infiltration may reveal some aspects of their clinical behaviour [ 4 ]. Moreover, they are related with inflammatory response and that derives from the fact that infection indicators are detected in abnormal levels in laboratory tests, such as the elevation of C –reactive protein (CRP) or erythrocyte sedimentation rate (ESR), while sometimes there are also clinical symptoms, such as fever, fatigue or weight loss [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Autopsy of 54 cases of surgically excised cardiac myxomas. Investigation of their impact on immune response

Michopanou

Schizas

Charitos

et al. 2020

Heliyon

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Introduction The impact of cardiac myxomas on the immune response is still indefinite, although laboratory tests and histological findings suggest that there is a correlation between myxomas and inflammatory reaction. Objectives Our study speculates that cardiac myxomas are associated with inflammatory response and investigates potential elements of inflammation in the histopathological examination and biomarkers from laboratory tests. Methods It is a retrospective study and data were collected from a single center between May 2010 to May 2018. Autopsies and laboratory tests of 54 cases were analyzed. Results In 20,4% of the autopsies, inflammatory elements were identified. The neutrophil/lymphocyte ratio (NLR) preoperatively is elevated in patients suffering from cardiac myxoma while its value is correlated to the tumor size. Conclusions Cardiac myxoma is an entity that affects the immune response of patients. The biomarker NLR could be utilized as a prognostic factor regarding enlarged cardiac myxomas. Future studies still need to be conducted in order to confirm the usefulness of this biomarker on cardiac myxomas.

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Early and delayed neurological manifestations of cardiac myxomas

Cited by 6 publications

References 17 publications

Cerebral embolization associated with parenchymal seeding of the left atrial myxoma: Potential role of interleukin‐6 and matrix metalloproteinases

Cerebral embolization associated with parenchymal seeding of the left atrial myxoma: Potential role of interleukin‐6 and matrix metalloproteinases

Subarachnoid Hemorrhage Following Ischemic Stroke Caused by Atrial Myxoma

Autopsy of 54 cases of surgically excised cardiac myxomas. Investigation of their impact on immune response

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