Updated: 3/30/2017

Intramuscular Myxomas

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https://upload.orthobullets.com/topic/8080/images/mri.intramuscular myxoma.jpg
https://upload.orthobullets.com/topic/8080/images/myxoma 2.jpg
https://upload.orthobullets.com/topic/8080/images/histology intramuscular myxoma.jpg
 
Introduction
  • Benign soft tissue tumor that presents as a slow growing deeply seated mass confined within the skeletal muscle (intramuscular)
    • myxo from greek means mucus
    • likely develop from premature mesenchymal stem cells which differentiate into benign fibroblasts which loose their capacity to secrete collagen
  • Epidemiology
    • demographics
      • occur in 40 to 60 year olds
      • slight female predilection
    • associated conditions
      • commonly located in the thigh, shoulder, buttock, or upper arm
  • Associated conditions
    • Mazabraud's syndrome
      • a syndrome characterized by multiple intramuscular myxomas associated with monostotic or polyostotic fibrous dysplasia
    • myxoid liposarcomas
      • important to differentiate from a myxoid liposarcomas, which occurs in an intermuscular location
  • Prognosis
    • local recurrence and metastasis uncommon
Presentation
  • Symptoms
    • slowly growing mass
    • may or may not be painful
      • pain in soft tissue sarcomas is often based on compression of surrounding tissues like vessels or nerves
Imaging
  • MRI
    • homogeneous appearance 
    • bright T2 signal
    • dark T1 signal
    • intramuscular location
      • intramuscular location of myxomas is important to differentiate from myxoid liposarcoma, which occurs in an intermuscular location
Studies
  • Histology
    • characterized by bland and hypo-cellular myxoid stroma   
    • no cellular atypia
    • low nuclear to cytoplasmic ratio
    • no atypical mitosis
Treatment
  • Nonoperative
    • observation
      • indications
        • for asymptomatic lesions
  • Operative
    • marginal surgical excision 
      • indications
        • symptomatic benign low-grade tumors
      • neoadjuvant chemo-radiotherapy is not needed
      • local recurrence and metastasis uncommon
 

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(OBQ09.255) A 40-year-old male presents to your office with complaints of hip/leg pain for 6 months. He is otherwise healthy and denies trauma. Radiographs, MRI, and histology images are shown in figures A through D. What treatment do you suggest for this patient? Tested Concept

QID: 3068
FIGURES:
1

Observation

4%

(96/2343)

2

Physical therapy

1%

(20/2343)

3

Surgical excision

45%

(1045/2343)

4

Neoadjuvant chemotherapy followed by surgical excision

11%

(262/2343)

5

Surgical excision followed by adjuvant radiotherapy

39%

(915/2343)

L 4 D

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