Intracardiac Myxoma, Cerebral Aneurysms and Elevated Interleukin-6

Abstract

Cerebral aneurysms are well known to be associated with cardiac myxomas. The mechanism of cerebral aneurysm formation remains to be elucidated. Embolization of tumor particles in the vessel wall has been proposed as the likely mechanism for aneurysm formation. Recent reports suggest interleukin-6 (IL-6) may play a role as well. We describe a patient who presented with subarachnoid hemorrhage secondary to ruptured right middle cerebral artery (MCA) aneurysm and unruptured left MCA aneurysm. Subsequently, the patient was found to have an atrial myxoma and persistently elevated serum IL-6 levels. Transcranial Doppler monitoring showed multiple emboli in the right MCA vascular territory on day 1 after surgery but no recurrent embolization during the next 2 weeks on repeated tests. Elevated IL-6 levels were noted both on day 1 and on day 30. Our findings provide evidence that IL-6 elevation and not tumor embolization is likely the culprit for aneurysm formation in some patients with atrial myxoma.

Heart or head?: A depression mimic delays diagnosis—oncotic cerebral aneurysms caused by atrial myxoma

“…The pathogenesis of aneurysm formation is also not well known. 5 , 9 Embolisation of tumour particles to the cerebral vessel walls is favoured to be the predominant mechanism for aneurysm formation, with the embolised myxoma cells thought to induce aneurysm formation by penetrating and weakening the vascular walls. 4 – 6 , 9 …”

“… 1 , 7 Reports of persistently elevated serum Interleukin-6 (IL- 6) levels suggest that the pro-inflammatory effects of IL-6 may induce or contribute to aneurysm formation in a paracrine manner in some patients. 9 Atrial myxoma cells have been shown to produce IL-6 and in some patients, including some with new aneurysm formation post myxoma resection, persistently elevated serum IL-6 levels have been identified. 6 , 9 IL-6 has been postulated as a potential seromarker to predict patients at risk of delayed complications, but further research is required.…”

Interleukin-6 in cardiac surgery

“…A recent study demonstrated that circulation IL-6 level directly correlated with the tumor size, or with the recurrence of the tumors regardless of tumor size. According to the study, the overproduction of IL-6 by cardiac myxomas should be responsible for the constitutional symptoms and immunologic abnormalities in the patients, and might also serve as a marker of recurrence (34). The constitutional symptoms of cardiac myxoma patients for example, the onset fever of unknown origin of cardiac myxoma, might be mediated by .…”

“…The constitutional symptoms of cardiac myxoma patients for example, the onset fever of unknown origin of cardiac myxoma, might be mediated by . Myxoma is highly aggressive due to IL-6 production irrespective of the tumor size, and the serum IL-6 level decreased rapidly after the cardiac myxoma resection and it remained in the normal range, but it would be elevated again when recurrent (34,35). Therefore, IL-6 might also play a role in inducing the activation and proliferation of secondary foci in the event of multifocal recurrence.…”

Current challenges in the diagnosis and treatment of cardiac myxoma

“…25,26 A few studies showed decreased interleukin-6 levels in peripheral blood of patients who underwent CM resection. 27,28 On the other hand, the tumor is also said to produce inflammatory mediators itself. 25 To confirm this hypothesis, we need further studies on interleukin-6 levels, which would examine larger patient samples during a long -term follow-up after CM resection.…”