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Intracranial metastasis from a glandular variant of atrial myxoma

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Summary

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.

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Authors and Affiliations

  1. Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India

    A. V. Moiyadi & S. Sampath

  2. Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India

    A. A. Moiyadi, A. Mahadevan & S. K. Shankar

  3. Department of Pathology, Jayadeva Institute of Cardiology, Bangalore, India

    S. R. Kalpana

  4. Department of Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, India

    S. G. Srikanth

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  1. A. V. Moiyadi
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  2. A. A. Moiyadi
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  7. S. G. Srikanth
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Moiyadi, A., Moiyadi, A., Sampath, S. et al. Intracranial metastasis from a glandular variant of atrial myxoma. Acta Neurochir (Wien) 149, 1157–1162 (2007). https://doi.org/10.1007/s00701-007-1291-1

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