Atrial myxoma with remote metastasis: case report and review of the literature.

The occurrence of a metastatic atrial myxoma after complete resection of the intracardiac lesion is rare. We treated a 66-year-old man who 13 years earlier had undergone resection of a left atrial myxoma, which had been diagnosed during a work-up of symptomatic cerebellar infarcts. He initially had a painless nonpulsatile mass near the radial artery. Surgery was performed to confirm the presumptive diagnosis of calcified ganglion, and subsequently he was found to have a pseudoaneurysm. The pathologic examination identified the tissue as myxoma. The results of echocardiography and cardiac magnetic resonance imaging failed to reveal any residual or new intracardiac tumor. The patient subsequently experienced swelling of the right leg and was found to have a 6 x 10 cm mass in the medial portion of his proximal thigh. At exploration this mass was found to extend from the profunda femoris artery, and it also compressed the femoral vein. Pathologic evaluation based on histologic and electron microscopic features of this lesion confirmed this lesion to be myxoma. Review of the literature reveals that metastatic atrial myxoma is a rare lesion, and such a delayed occurrence after resection of the cardiac lesion has been infrequently reported. This suggests that patients with atrial myxoma may be at risk for the appearance of intravascular metastatic tumor long after resection of their original intracardiac tumor.