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Intracranial metastasis from a glandular variant of atrial myxoma
A V Moiyadi1, A A Moiyadi, S Sampath
1Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India. aliasgarmoiyadi@yahoo.com
Background:
Intracranial metastases from atrial myxoma producing symptomatic mass lesions are very rare with only ten examples reported in the literature. We report a patient with multiple metastases from a cardiac myxoma which had an unusual histopathology mimicking an adenocarcinoma.
Clinical Presentation:
A 35 year old man presented with left facio-brachial focal motor seizures unresponsive to antiepileptic drugs and these episodes preceded the symptoms of cardiac myxoma. The seizures worsened a year following resection of the cardiac myxoma. The MRI of the brain revealed multiple lesions of heterogeneous intensity, partly solid and cystic situated in the right fronto-parietal, left temporal and occipital lobes.
Findings:
Right fronto-parietal craniotomy revealed lesions with haemorrhagic, calcified areas and a large cystic component was decompressed. Histological examination of the lesions in the brain demonstrated prominent glandular differentiation, identical in morphology to the primary cardiac lesion of a glandular variant of atrial myxoma.
Conclusion:
This report highlights the rare presentation of atrial myxoma with intracranial metastases and reviews previously reported examples. This is only the second case report of a glandular variant of atrial myxoma with metastases to the brain. A pathologist, unaware of this unusual variant of primary atrial myxoma, may mistake the intracranial lesion for a metastatic adenocarcinoma.
