Non-oncologic metastases

Cardiac myxoma (CM) is the most common benign primary cardiac tumour in adults. Almost concerns the left atrium, being more frequent in middle-aged women. They can be asymptomatic, and the diagnosis can be incidental in an echocardiography or they can cause constitutional, intracardiac obstructive, thrombus, or embolic tumour fragments manifestations. The last can occur in 25–50% of the cases and predominantly affects brain circulation.1,2 A 65-year-old woman with hypertension, diabetes mellitus, dyslipidaemia, morbid obesity, and obesity-hypoventilation syndrome, with exertional dyspnoea is following in cardiology consultation after incidental diagnosis of left atrial CM (see Panel A; Supplementary data online, Video S1) without valvulopathies, heart disfunction, or another manifestation. It was removed with intraoperative transoesophageal echocardiogram without residual tumour (see Supplementary data online, Video S2). Six months later, she presented with tonic–clonic crisis. The head images showed multiple space-occupying lesions in both hemispheres, cerebellum, and extra-axial with signs of recent bleeding and surrounded by oedema (Panels B–D). The left frontal lesion was the biggest (see Supplementary data online, Figure S1). A craniectomy of this lesion was done, and anatomopathological analysis revealed CM metastases. The other lesions were treated with whole-brain radiotherapy. Metastatic brain lesions are rare neurologic complication of CM. Few cases were described, and physiopathological mechanisms are unknown. Even if CM is completely removed by a surgical excision, despite rare, metastatic lesions can happen, as is already the case. For that, even after complete surgical excision, these patients should be followed regularly with echocardiography. Nevertheless, the time of surveillance is unknown.3–5 I appreciate the contributions of my colleagues, also doctors, David González; Cristina Gomez-Varela and Andrés Iñiguez Romo to the contribution of creating this manuscript. Supplementary data are available at European Heart Journal online. All authors declare no disclosure of interest for this contribution. No data were generated or analysed for this manuscript.