Republished: Mechanical thrombectomy for repeated cerebral tumor embolism from a thoracic sarcomatoid carcinoma

Abstract

Cerebral embolism originating from intracardiac tumors represents a rare cause of stroke and has been documented in both adult and pediatric populations. We present a patient recently diagnosed with a right pulmonary hilum tumor, invading the pulmonary veins and the left atrium. Two consecutive episodes of large cerebral vessel occlusion in separate vascular territories occurred in the same day and were treated by mechanical thrombectomy. Embolic material retrieved on both occasions contained tumor fragments with peripheral endothelialization. To our knowledge, this is the first report with histological confirmation of cerebral embolism from an invasive extracardiac tumor.

Mechanical Thrombectomy for Acute Middle Cerebral Artery Occlusion Caused by Tumor Embolism: A Case Report

“…The thrombi retrieved from the four patients with cerebral embolization due to extracardiac tumors shown in Table 1 were white and hard, and had different morphological characteristics from usual thormbi. 1 , 10 , 11 , 14) However, the appearance and elasticity of the embolus in our patient did not differ from those of usual thrombi. We initially considered the etiology of infarction to be cardiogenic cerebral embolism because of the history of paroxysmal atrial fibrillation, but eventually diagnosed as tumor embolism based on pathological findings.…”

“…Of the 15 reported cases of tumor embolism, 4 had extracardiac tumor. Of the four cases of extracardiac tumor, three had lung cancer infiltrating the pulmonary vein and left atrium, 10 , 11 , 14) and one had phyllodes tumor of the breast with pulmonary metastasis invading the pulmonary vein. 1) …”

A Case of Pediatric Stroke: Osteosarcoma Embolus in the Internal Carotid Artery

“…She was noted to have large masses in both atria which were thought to be the nidus for tumor embolus. While this case and others [14, 15] demonstrate successful endovascular mechanical thrombectomy for tumor emboli in adults, mechanical thrombectomy in the pediatric population presents additional technical challenges given the smaller size of the patients and their vasculature, which can significantly limit device selection. In one of the larger retrospective studies of thrombectomies in children, Sporn et al [6] showed that younger children had poorer outcomes in their group, which could be partially due to the smaller vessel size and more difficult access in those patients.…”

Delayed emergence from anesthesia caused by an intraoperative cerebral embolism of a malignant peripheral nerve sheath tumor in a neurofibromatosis type 1 patient: a case report

“…Cerebral artery tumor embolism induces acute neurological disorder; however, it is rarely diagnosed because of its low incidence and necessity of histological confirmation [ 12 , 13 ]. There is one published review of histological diagnoses of 14 cases which had undergone endovascular mechanical embolectomy for tumors causing acute cerebral ischemic stroke [ 14 ].…”