Cerebral Metastasis From Recurrent Atrial Myxoma: A Case Report

BACKGROUND Atrial myxomas are benign cardiac tumors that can embolize and cause arterio-occlusive complications associated with substantial morbidity and mortality. Recurrence after surgical resection is uncommon, and distant metastasis is exceedingly rare. We describe a young patient who concomitantly experienced 2 rare and serious manifestations of atrial myxoma: tumor recurrence after many years and cerebral metastasis. CASE REPORT A 33-year-old man with a history of left atrial myxoma resection at age 19 presented with sudden onset of right facial paresthesia and right arm weakness. Brain imaging revealed bilateral ischemic strokes in the middle cerebral artery territories, leading to suspicion of embolic etiology. Echocardiography confirmed recurrence of the left atrial myxoma; repeat surgical excision was necessary. Several months after surgery, the patient developed new neurologic symptoms. Brain magnetic resonance imaging demonstrated multifocal hemorrhagic lesions with associated vasogenic edema, suggesting metastatic disease. Surgical resection of a left frontal lesion revealed organizing hemorrhage with rare calretinin- and S100-positive cells, implying myxomatous origin. One year later, the patient underwent right parietal craniotomy and gamma knife radiosurgery; pathology confirmed myxomatous tissue intermixed with hemorrhagic and inflamed brain parenchyma. Follow-up echocardiography showed no intracardiac recurrence, indicating that cerebral seeding likely occurred before the second cardiac surgery. CONCLUSIONS This case highlights 2 rare complications of atrial myxoma in a single patient: delayed recurrence and cerebral metastasis. It underscores the need for long-term surveillance, even decades after initial resection, and the consideration of central nervous system metastatic disease in patients with neurologic symptoms and a history of cardiac myxoma.