Intramuscular myxoma of the longus colli mistaken for a cervical rootlet schwannoma

Abstract

An 86-year-old woman was referred to the otolaryngology clinic for a 1-year history of a painless, slow-growing neck mass. Physical examination showed a fixed, immobile right level II neck mass with normal vocal cord movement. MRI demonstrated a lobulated mass laterally displacing the carotid vessels, consistent with a schwannoma. Despite the pathognomonic radiographic findings for schwannoma, core needle biopsy of the mass was consistent with intramuscular myxoma (IM), which rarely presents in the head and neck region. After multiple years of slow growth with bulging into the pharynx, the patient ultimately underwent surgery to reduce the risk of airway compromise. The location of this IM together with its unusual imaging appearance is a unique finding in the head and neck and adds to the differential diagnoses for neck masses displacing the carotid sheath.

Intramuscular Myxoma of the Intrinsic Muscles of the Tongue: A Case Report with Literature Review

“…Intramuscular myxomas in the head and neck are rare. To the best of our knowledge, 33 cases of intramuscular myxomas in the head and neck, including the present case, have been reported in the literature to date [ 3 – 34 ]. These cases are summarized in Table 1 .…”

“…Only one case was correctly diagnosed as a myxoma [ 13 ]. A diagnosis of myxoma was not reached in the remaining seven cases [ 12 , 15 , 18 , 20 , 23 , 26 , 34 ]. Therefore, it is difficult to achieve the correct diagnosis of myxoma by fine needle aspiration cytology.…”