Neuroimaging characteristics and long-term prognosis of myxoma-related intracranial diseases

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

“…They found that eight (67%) patients had multiple intracranial aneurysm, and that six (50%) patients exhibited extravascular "metastasis". 18 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).…”

“…followed 12 patients treated for left atrial myxoma with predominant neurological manifestations. They found that eight (67%) patients had multiple intracranial aneurysm, and that six (50%) patients exhibited extravascular “metastasis” 18 …”

“…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 …”

Systemic Inflammation in the Setting of Cardiac Myxomas: an Overview of Clinical and Practical Considerations

“… 7) 8) In this context, ‘distant tumoral seeding’ is mostly characterized by the involvement of central nervous system (CNS), and presents with cranial aneurysm formation and solid parenchymal lesions in association with variable degrees of hemorrhagic parenchymal lesions. 8) 9) Mechanistically, these distant myxomatous lesions have been attributed to the transmigration of myxoma cells through the cerebrovascular endothelial cells with the particular actions of certain proinflammatory mediators including IL-6 and consequent expression of intercellular adhesion molecule-1. 7) 8) 9) Of note, these distant CNS lesions might potentially arise any time in patients with cardiac myxoma (even after several years following resection [namely systemic recurrence]).…”

“… 8) 9) Mechanistically, these distant myxomatous lesions have been attributed to the transmigration of myxoma cells through the cerebrovascular endothelial cells with the particular actions of certain proinflammatory mediators including IL-6 and consequent expression of intercellular adhesion molecule-1. 7) 8) 9) Of note, these distant CNS lesions might potentially arise any time in patients with cardiac myxoma (even after several years following resection [namely systemic recurrence]). 8) 9) In general, surgery, chemotherapy and radiotherapy constitute the fundamental management strategies for the established CNS lesions.…”