J Korean Soc Magn Reson Med.  2011 Aug;15(2):165-169. 10.13104/jksmrm.2011.15.2.165.

Delayed Cerebral Metastases from Completely Resected Cardiac Myxoma: Case Report and Review of Literature

• Kim AH
• Lee JW
• Lee MK
• Yoon PH
• Kim MJ

• KMID: 2000066
• DOI: http://doi.org/10.13104/jksmrm.2011.15.2.165

Abstract

Cardiac myxoma is the most common benign tumor of the heart. However, low incidence of recurrence and metastasis has been reported. A 49-year-old female patient was admitted in the hospital due to sudden onset of left side weakness. Magnetic resonance imaging (MRI) of brain showed multifocal areas of diffusion restriction on diffusion weighted images. Echocardiography was performed to evaluate the cause of embolic brain infarction and cardiac myxoma was found in the left atrium. The patient underwent complete excision of the mass. One year later, the patient was readmitted with symptoms of dysarthria. Brain MRI showed newly developed multiple hemorrhagic metastatic lesions. The patient underwent radiotherapy of the metastatic lesions. Although rare, cardiac myxoma can cause delayed metastasis. We report a rare case of delayed multiple cerebral metastases from the completely resected cardiac myxoma.

Keyword

Cardiac myxoma; Delayed cerebral metastases; Magnetic resonance imaging

MeSH Terms

Brain
Brain Infarction
Diffusion
Dysarthria
Echocardiography
Female
Heart
Heart Atria
Humans
Incidence
Magnetic Resonance Imaging
Middle Aged
Myxoma
Neoplasm Metastasis
Recurrence

Figure

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  Fig. 1 A 49-year-old female patient underwent resection of the cardiac myxoma that caused multiple cerebral embolic infarction. Photomicrograph of the histopathologic specimen shows spindled and stellite cells with eosinophilic cytoplasm and round to slender nucleus embedded in pale edematous myxoid matrix. No significant cytologic atypia including marked pleomorphism and abnormal mitotic figures was seen (H-E, ×400).

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  Fig. 2 Patient unerwent MRI due to symptoms of sudden dysarthria 1-year after resection of cardiac myxoma. (a) T2-weighted image shows multiple peripheral dark signal intensity rims in bilateral cerebral hemispheres, and adjacent superficial siderosis, suggestive of hemorrhagic metastases. (b) T1-post contrast image shows enhancement of the metastatic lesions.

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  Fig. 3 Follow up MRI was performed 3-weeks after whole-brain radiotherapy. (a) T2-weighted image shows residual hemorrhagic metastatic lesions in the brain. (b) T1-post contrast image shows decrease in size of enhancing portions suggestive of favorable therapy response.

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