Diagnostic and Therapeutic Pathways of Intramuscular Myxoma

Abstract

Intramuscular myxomas (IMMs) are benign tumors. Evidence regarding diagnostic and therapeutic pathways is rare, and guidelines do not exist due to their low incidence. The aim of this study was a retrospective analysis at a university cancer center and the interdisciplinary re-evaluation of the individual diagnostic and therapeutic procedures. Overall, 38 patients were included in the study. IMMs occurred mostly in middle-aged women. At the time of first consultation, 57.9% had few symptoms or were asymptomatic. In 92.1% of the cases, the tumor was localized in the extremities. The lower extremity was affected in 73.7%. The average size of IMMs was 5.0 cm. The proximally located tumors in the gluteus, thighs, and upper arms were significantly larger (p = 0.02) than the distally-located tumors in the forearms and lower legs. An MRI was performed in 97.4%. Based on imaging, an IMM was suspected in 5.6% by radiologists and in 54.1% by musculoskeletal surgeons. An incision biopsy was performed in 68.4% and led in 100.0% to the right histopathological diagnosis. In total, 89.5% of IMMs were resected. Postoperative complications requiring revision occurred in 8.8%. Recurrences or degenerations of IMMs were not reported in any of these cases.

Rare forearm intramuscular myxoma: a case report

“…Cytology-histopathology findings with the help of intraoperative frozen section and needle biopsy help the information of MRI sections in the diagnosis of IMM. Density and ratio of cells/ collagen fibers, mucoid material secretion, nodular-vesicular pattern and fat density in histopathological sections contribute to IMM (7). In the present case, forearm intramuscular myxoma was observed inter-supinator muscle.…”

“…In the present case, the mass has a thin capsule around the homogenous hypocellular mucoid tissue, in which the spindle-shaped cells (fibroblasts) are located in scattered collagen fibers. The reports of the upper extremity IMM cases show that the lesions in the muscles are removed subcutaneously after surgery and cause few complications (11). Movement limitations caused by IMM are also quickly resolved with physiotherapy if the nerves of the brachial plexus are not compressed.…”

Rare forearm intramuscular myxoma: A case report

“…In the present case, the mass has a thin capsule around the homogenous hypocellular mucoid tissue, in which the spindle‐shaped cells (fibroblasts) are located in scattered collagen fibers. Reports of upper extremity IMM cases show that lesions in the muscles are typically removed subcutaneously after surgery, causing few complications 7 . Movement limitations caused by IMM are quickly resolved with physiotherapy if the nerves of the brachial plexus are not compressed.…”

“…IMM is a rare benign soft tissue tumor that is believed to occur due to incomplete differentiation of mesenchymal cells into fibroblasts. However, it can also be a part of McCune‐Albright syndrome and Mazabraud's syndrome, caused by mutations in the GNAS gene 6,7 . The term myxoma was first applied by Virchow in 1863 to describe a soft tissue tumor of mesenchymal cell origin.…”

“…However, it can also be a part of McCune‐Albright syndrome and Mazabraud's syndrome, caused by mutations in the GNAS gene. 6 , 7 The term myxoma was first applied by Virchow in 1863 to describe a soft tissue tumor of mesenchymal cell origin. Stout, in 1948, described the histopathologic criteria for the diagnosis of myxoma and its differentiation from other lesions.…”