Subject(s)
Orbital Neoplasms/secondary , Osteosarcoma/secondary , Sarcoma/pathology , Sphenoid Bone/pathology , Thoracic Wall/pathology , Adult , Combined Modality Therapy , Humans , Male , Ophthalmologic Surgical Procedures , Orbital Neoplasms/therapy , Osteosarcoma/therapy , Radiotherapy , Sarcoma/therapyABSTRACT
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.
Subject(s)
Brain Neoplasms/secondary , Cerebral Cortex , Heart Atria , Heart Neoplasms/secondary , Myxoma/diagnosis , Neoplasms, Glandular and Epithelial/secondary , Adult , Brain Neoplasms/diagnosis , Brain Neoplasms/pathology , Brain Neoplasms/surgery , Cerebral Cortex/pathology , Cerebral Cortex/surgery , Craniotomy , Diagnosis, Differential , Follow-Up Studies , Heart Atria/pathology , Heart Atria/surgery , Heart Neoplasms/diagnosis , Heart Neoplasms/pathology , Heart Neoplasms/surgery , Humans , Magnetic Resonance Imaging , Male , Myxoma/pathology , Myxoma/surgery , Neoplasms, Glandular and Epithelial/diagnosis , Neoplasms, Glandular and Epithelial/pathology , Neoplasms, Glandular and Epithelial/surgery , Reoperation , Tomography, X-Ray ComputedABSTRACT
Neurological manifestations in Paget's disease are rare. Hydrocephalus is infrequent, its etiology in Paget's disease being multi-factorial. Surgical and anesthetic procedures may be challenging, requiring special precautions. We describe one such case and discuss these peculiarities. An elderly lady, diagnosed to have Paget's disease presented with features of recent onset dementia, gait disturbances with urinary incontinence. Hydrocephalus secondary to posterior fossa crowding was present. A ventriculo-peritoneal shunt was inserted. Endotracheal intubation proved to be difficult. Modification of the surgical technique was required to ensure a safe procedure. She improved immediately following CSF diversion. Timely CSF diversion yields good results. Certain precautions during anesthesia and surgery can ensure a safe and uneventful peri-operative period.
