Cardiac myxoma

IL-6 induces terminal maturation of B cells, promotes the growth of hy-bridoma/myeloma cells and T cells, and acts upon haematopoietic progenitors in synergy with IL-1 and IL-3. It also induces the production of acute-phase proteins by liver cells. In addition to its production by neutrophils, IL-6 is also synthesised by monocytes, T and B cells, fibroblasts, cardiac myxoma cells, some bladder carcinomas, cervical cancer cells and glioblastomas. Stimulated neutrophils generate about ten times less IL-6 (on a per-cell basis) than do monocytes. 

Serum IL-6 levels are usually very low or not measurable prior to middle age. However, subsequent IL-6 dysregulation results in increased production such that it is readily measurable in older persons even in the absence of inflammation. It has been suggested that dysregulation of IL-6 gene expression may be related to increased autoantibody production and the presence of benign paraproteinemia, both of which are commonly present in the elderly (Rl). Moreover, increased IL-6 levels may be responsible for the age-associated development of malignant B-cell tumors. In addition, Ershler (E4) noted that increased IL-6 has been associated with alteration of amyloid precursor protein, as is present in Alzheimer s disease, and stimulation of postmenopausal bone resorption. IL-6 has also been implicated in multiple myeloma, lymphoma, rheumatoid arthritis, Castleman s disease, and cardiac myxoma (E4). 

Ruby RJ, Burton JR (1977). Acute reversible hemiparesis and hyponatremia. Lancet i 1212 Sabolek M, Bachus-Banaschak K, Bachus R et al. (2005). Multiple cerebral aneurysms as delayed complication of left cardiac myxoma a case report and review. Acta Neurology Scandinavica 111 345-350 Sacco RL, Kargman DE, Gu Q et al. (1995). Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 26 14-20 Salgado AV (1991). Central nervous system complications of infective endocarditis. 

Stroke in the context of preceeding malaise for up to some months suggests an inflammatory arterial disorder, particularly giant cell arteritis, infective endocarditis, cardiac myxoma, cancer, thrombotic thrombocytopenic purpura or even sarcoidosis (Ch. 6). 

Fever is unusual in the first few hours after stroke onset, and endocarditis or other infections, inflammatory vascular disorders or cardiac myxoma should be considered. Later fever is quite common and usually reflects a complication of the stroke (Ch. 16). 

Carney JA. Psammomatous melanotic schwannoma A distinctive, heritable tumor with special associations, including cardiac myxoma and the Cushing syndrome. Am J Surg Pathol. 1990 14 206-222. 

Elevated levels of IL-6 have been found in cardiac myxoma (J5) and Castle-man s disease (Y8). In both cases IL-6 is elaborated by tissues affected by the disease and gives rise to fever, acute phase protein production, and hypergammaglobulinemia, features typical of the acute phase response elicited by this cytokine. Raised serum levels of IL-6 have been detected in patients with bums (N6, P19) and following surgical procedures (C38, N8, P21). Nijsten (N6) showed... 

Jourdan, M., Bataille, R., Seguin, J., Zhang, X. G., Chaptal, P. A., and Klein, B. Constitutive production of interleukin-6 and immunologic features in cardiac myxomas. Arthritis Rheum. 33, 398-402 (1990). 

Ekinci El, Donnan GA Neurological manifestations of cardiac myxoma a review of the literature and report of cases. Intern Med J 2004 34 pp. 243-249. 

Cardiac myxoma may be a very rare cause of SAH. In exceptional cases it may metastasize into an intracranial artery, infiltrate the vessel wall and initiate aneurysm formation, even more than 1 year after excision of the primary tumour (Furuya et al. 1995). 

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