Samia Arthur M, Boyer Philip J
Dermatology, University of Florida, Gainesville, USA.
Pathology and Laboratory Medicine, Vidant Medical Center/East Carolina University, Greenville, USA.
Cureus. 2023 Jul 3;15(7):e41323. doi: 10.7759/cureus.41323. eCollection 2023 Jul.
Atrial myxomas are the most common primary neoplasm of the heart. Due to their mass effect, they may lead to dysfunction of the heart or mitral valve. Rarely, neoplastic fragments may embolize or a thrombus secondary to stasis may form, which can infarct downstream structures (e.g., the brain). We report the case of a 59-year-old man presenting with headaches, visual changes, and word-finding difficulty secondary to multifocal brain lesions that were identified on computed tomography and magnetic resonance imaging. After an extensive workup, the etiology of the patient's neurological symptoms was determined to be embolization from a large atrial myxoma (2.3x3.5 cm). Histologic and immunohistochemical examination of the atrial myxoma and largest brain lesion yielded similarities, including the presence of spindle-shaped and stellate cells, myxoid regions, Alcian blue pH 2.5 positivity, calretinin positivity, cluster of differentiation 34 (CD34) positivity, and cluster of differentiation 68 (CD68) negativity. This case was remarkable due to the patient's late presentation, the large size of the atrial myxoma, the presence of abundant cerebral hemisphere and cerebellar lesions, and the histologic comparison of the heart and brain lesions. Atrial myxomas have been reported from childhood to late adulthood and when symptoms typically present clinically due to the mass effect. However, neurologic manifestations from embolization or thrombus formation can occur, as in the present case. Therefore, considering the presence of atrial myxomas is important in patients with neurologic manifestations and heart murmurs.
心房黏液瘤是心脏最常见的原发性肿瘤。由于其占位效应，可导致心脏或二尖瓣功能障碍。罕见情况下，肿瘤碎片可能会发生栓塞，或因血流淤滞继发形成血栓，进而导致下游结构（如脑）梗死。我们报告了一例59岁男性患者，因计算机断层扫描和磁共振成像发现多灶性脑病变，出现头痛、视力改变和找词困难。经过全面检查，确定患者神经症状的病因是一个大的心房黏液瘤（2.3×3.5厘米）栓塞。对心房黏液瘤和最大的脑病变进行组织学和免疫组化检查发现有相似之处，包括存在梭形和星状细胞、黏液样区域、阿尔辛蓝pH 2.5阳性、钙视网膜蛋白阳性、分化簇34（CD34）阳性和分化簇68（CD68）阴性。该病例很显著，原因在于患者就诊较晚、心房黏液瘤体积大、存在大量大脑半球和小脑病变，以及心脏和脑病变的组织学比较。心房黏液瘤在儿童期至成年晚期均有报道，通常因占位效应而出现临床症状。然而，如本例所示，栓塞或血栓形成也可导致神经表现。因此，对于有神经表现和心脏杂音的患者，考虑心房黏液瘤的存在很重要。
