Metastatic lesions of atrial myxoma. A pathologist can clinch them all

Rajeshwari, Madhu; Subramanian, Priyadarsani; Suri, Vaishali; Nambirajan, Aruna; Garg, Ajay; Vibha, Deepti; Phalak, Manoj; Sharma, Mehar Chand

doi:10.1111/neup.12640

Cited by 4 publications

(4 citation statements)

References 15 publications

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“…The potential for myxomatous embolism is thought to be due to the tumor’s friable and villous qualities, as well as its tendency to degenerate, either through fibrosis, necrosis, thrombosis, calcification, or Gamna–Gandy body formation. [ 4 , 7 ] Tumor cells seeded within the embolus then proliferate to form a metastatic lesion. [ 7 ] Patient presentation may vary depending on the location of the metastasis, but typically resembles hemorrhagic infarction of the affected area.…”

Section: Discussionmentioning

confidence: 99%

“…[ 4 , 7 ] Tumor cells seeded within the embolus then proliferate to form a metastatic lesion. [ 7 ] Patient presentation may vary depending on the location of the metastasis, but typically resembles hemorrhagic infarction of the affected area. [ 3 ] It is usually recommended to remove the primary cardiac lesion before brain metastases unless there are urgent indications for surgery, such as hemorrhage with significant mass effect or progressive neurologic deficits.…”

Section: Discussionmentioning

confidence: 99%

“…[ 5 ] Postoperative chemotherapy with either ifosfamide and doxorubicin or doxorubicin alone has also been attempted in patients with multifocal disease, though with mixed results. [ 7 ] One case report even documents the use of Gamma Knife radiosurgery to treat cerebral metastases, without recurrence of disease 2 years postoperatively. [ 4 ] Despite these interventions, recurrence of disease is common, even after surgical resection of the primary atrial tumor.…”

Section: Discussionmentioning

confidence: 99%

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Multiple craniotomies for the resection of symptomatic multifocal intracranial metastatic cardiac myxoma: A case report

Abdow III,

Breton,

Nayar

2023

Surgical Neurology International

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Background: Myxomas, rare benign mesenchymal lesions, are the most common cardiac tumors. Patients may rarely develop hematogenous metastasis to the brain, which can present as new-onset neurological deficits that correlate with multifocal hemorrhagic lesions on imaging. Limited guidelines presently exist for the treatment of such lesions. This report outlines a unique case involving three craniotomies and failed radiation therapy in the treatment of metastatic cardiac myxoma. Case Description: A 63-year-old woman presented with a right middle cerebral artery embolic stroke secondary to a left atrial myxoma and multifocal hemorrhagic lesions consistent with intracranial metastasis. She had a right frontal craniotomy for tumor resection, followed by stereotactic radiosurgery, though this did not arrest disease progression. She later had a left occipital craniotomy for a symptomatic lesion. More than two years after her initial presentation, she returned with acute-onset symptoms correlating to growth in a left frontal lesion requiring another resection. Following this third craniotomy, imaging has not revealed the progression of metastatic intracranial disease. She is pursuing further treatment through primary cardiac tumor resection. Conclusion: Although rare, hematogenous seeding with subsequent formation of hemorrhagic metastasis is a possible complication of atrial myxoma. While surgical resection, radiation therapy, and chemotherapy have historically been used, no standard of care currently exists. This case demonstrates repeat tumor resection as effective for managing symptomatic intracranial metastatic myxoma in a patient with poor response to radiation therapy and multiple recurrences, with follow-up showing improvement in neurological symptoms and mass effect and absence of recurrence on imaging.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Multiple craniotomies for the resection of symptomatic multifocal intracranial metastatic cardiac myxoma: A case report

Abdow III,

Breton,

Nayar

2023

Surgical Neurology International

View full text Add to dashboard Cite

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“…13 Neurologic symptoms will occur in $ 30% of patients with an atrial myxoma, and in almost half of these, the neurologic manifestation will precede the cardiac symptoms. 14 Three distinct neurological presentations have been described: 15 1. Embolic ischemic stroke.…”

Section: Discussion Clinical Presentation and Pathogenesismentioning

confidence: 99%

Oncotic (Myxomatous) Aneurysms: A Review of Management

Peres

Brito

Peres

et al. 2022

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Atrial myxomas are the most common primary cardiac tumors and may manifest with neurological symptoms in ∼ 30% of cases. Cerebral ischemia, aneurysmal formation, and extravascular metastases are mechanisms that lead to these neurological manifestations. Perilesional changes on computed tomography (CT) and magnetic resonance imaging (MRI) may help in the diagnosis of myxomatous aneurysms, which are usually located in the distal middle cerebral artery (MCA) and in the posterior cerebral artery (PCA) circulation territories. Careful resection of the cardiac lesion is essential for preventing embolism. However, treatment of myxomatous aneurysms is controversial due to the limited understanding of the natural history of this condition. Treatment may include clinical observation in asymptomatic patients, surgical resection, endovascular approaches, adjuvant chemotherapy, and low-dose radiation therapy. We present one case of a female patient with myxomatous aneurysm secondary to an atrial myxoma who presented with neurological symptoms and another case of a female patient who developed neurological symptoms after initial surgical treatment of the primary lesion. Lesion growth rate, topography, morphology, and the patient's clinical condition must be considered when choosing a therapeutical method. Further clinical studies are needed to achieve a better understanding and treatment of this disease.

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Distinctive phenogroup to differentiate diagnosis of cardiac myxoma vs cardiovascular disease examining blood-based circulating cell biomarkers

Donato,

Mignogna,

Santise

et al. 2023

Sci Rep

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Cardiac myxoma (CM) is a potentially life-threatening disease because frequently asymptomatic or debuts with aspecific manifestations. Definitive diagnosis is established by histopathological assessment including tumor and endothelial cell markers. To derive a specific panel of circulating cells antigenically detectable, pre-surgery peripheral blood samples of CM patients were analyzed. Pre-surgery peripheral blood samples from patients with CM were simultaneously analyzed for Circulating tumor cells (CTCs) and circulating endothelial cells (CECs) that were matched with tumor tissue profiles and with patient-derived xenografts (PDXs) distinguishing tumor regions. Moreover, CECs values in CM patients were further matched with CEC’s levels in cardiovascular disease and control subjects. The blood-derived cytological specimens detected at least 1–3 CTCs/ml in 10 tested CM samples (p = 0.0001) showing specific CM features preserved in the central zones of the tumor. The central zone of the primary tumor, supported by a vessel density rate (55 ± 7%), with a proliferative profile of 32 ± 3% and a percentage of Calretininpos cells (p = 0.03), is the principal site of CTCs (r = 00) dissemination. The subsets of endothelial cells recognized in the blood were indifferent to their topological distribution within the tumor and corresponding PDXs. With further refinement and validation in large cohorts, multiparametric liquid biopsies can optimally integrate clinically informative datasets and maximize their utility in pre-surgery evaluation of CM patients. Blood-derived culture’s protocol provides a versatile method capable of viable analysis of CTCs of non-hematological rare tumors which conventional antibody-mediated analytical platform is unable to perform. Distinctive blood- based cell phenotype contributes to differentiate CM from other differentials assuring its prompt surgical resection by combining blood-based cell biomarkers integrated with clinically informative datasets.

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Metastatic lesions of atrial myxoma. A pathologist can clinch them all

Cited by 4 publications

References 15 publications

Multiple craniotomies for the resection of symptomatic multifocal intracranial metastatic cardiac myxoma: A case report

Multiple craniotomies for the resection of symptomatic multifocal intracranial metastatic cardiac myxoma: A case report

Oncotic (Myxomatous) Aneurysms: A Review of Management

Distinctive phenogroup to differentiate diagnosis of cardiac myxoma vs cardiovascular disease examining blood-based circulating cell biomarkers

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