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Kašpar L, Balko J, Strnadová M, Krsková L, Máška D, Zámečník J. Mazabraud's syndrome: A case report supported by molecular studies and review of the literature. Bone Rep 2023; 18:101685. [PMID: 37250204 PMCID: PMC10220459 DOI: 10.1016/j.bonr.2023.101685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023] Open
Abstract
Mazabraud's syndrome represents rare benign disorder characterized by simultaneous occurrence of fibrous dysplasia of bone and intramuscular myxomas within surrounding soft tissue. Mutations of GNAS1 gene were proven to be causative for this condition. Here, we present a case report of a patient with unusual manifestation of this disease, who developed a pathological fracture of the femur in the setting of monostotic fibrous dysplasia. The intramuscular myxoma of the thigh was discovered during the following orthopedic operation, where the intraoperative diagnosis became a pitfall of the case, as the intramuscular myxoma was initially diagnosed as a low-grade sarcoma from the frozen section. Apart from clinical findings, the diagnosis of Mazabraud's syndrome was further proven by histopathological evaluation and molecular studies of GNAS1 gene. This case raises awareness of such condition as it can easily become a diagnostic pitfall.
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Affiliation(s)
- Ludvík Kašpar
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic
| | - Jan Balko
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic
| | - Martina Strnadová
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic
| | - Lenka Krsková
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic
| | - David Máška
- Department of Adult and Pediatric Orthopaedic Surgery and Traumatology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic
| | - Josef Zámečník
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic
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Pirmohamadi H, Begloo MJ, Rahimi M, Akbaribazm M. Rare forearm intramuscular myxoma: A case report. Clin Case Rep 2023; 11:e7467. [PMID: 37266345 PMCID: PMC10230414 DOI: 10.1002/ccr3.7467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/03/2023] Open
Abstract
Key Clinical Message Intramuscular myxoma (IMM) is a benign soft tissue tumor of mesenchymal origin that occurs mainly in skeletal muscles which can be removed through surgery after diagnosis. Abstract Intramuscular myxoma (IMM) is a benign soft tissue tumor of mesenchymal origin that typically occurs in skeletal muscles. Its diagnosis is based on magnetic resonance imaging (MRI) and histopathologic evaluation of the lesion. In our report, we describe the case of a 60-year-old female with an IMM in the supinator muscle of the right forearm, which was confirmed by MRI and histopathologic examination. Following surgery to remove the mass, a follow-up confirmed the patient's recovery and the absence of movement limitations in the elbow joint.
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Affiliation(s)
- Hosein Pirmohamadi
- Trauma Research CenterBaqiyatallah University of Medical SciencesTehranIran
| | | | - Mohsen Rahimi
- Health Research CenterLife Style Institute, Baqiyatallah University of Medical SciencesTehranIran
| | - Mohsen Akbaribazm
- Department of Basic Medical SciencesKhoy University of Medical SciencesKhoyIran
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3
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Diagnostic and Therapeutic Pathways of Intramuscular Myxoma. Diagnostics (Basel) 2022; 12:diagnostics12071573. [PMID: 35885479 PMCID: PMC9316518 DOI: 10.3390/diagnostics12071573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/19/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
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.
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Riley GM, Kwong S, Steffner R, Boutin RD. MR Imaging of Benign Soft Tissue Tumors. Radiol Clin North Am 2022; 60:263-281. [DOI: 10.1016/j.rcl.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hagelstein-Rotman M, Appelman-Dijkstra NM, Boyce AM, Chapurlat R, Dur NBJ, Gensburger D, Majoor BCJ, van de Sande MAJ, Dijkstra PDS. Extent of Extraskeletal Manifestations of Fibrous Dysplasia/McCune-Albright Syndrome in Patients with Mazabraud's Syndrome. Calcif Tissue Int 2022; 110:334-340. [PMID: 34854944 DOI: 10.1007/s00223-021-00918-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/20/2021] [Indexed: 11/27/2022]
Abstract
Mazabraud's syndrome (MZB) is a rare condition in which fibrous dysplasia of bone/the McCune-Albright syndrome (FD/MAS) co-exists with intramuscular myxomas. Both FD and the myxomas harbor the GNAS-mutation. Recent studies have shown that extraskeletal, GNAS-related features are associated with a more severe phenotype of FD/MAS. However, patients with MZB are often only seen by orthopedic surgeons. We therefore evaluated MZB patients seen in tertiary referral centers from the Netherlands (LUMC), USA (National Institutes of Health) and France (INSERM UMR 1033 (Lyos), Hôpital Edouard Herriot). All FD/MAS patients known in these centers with an additional diagnosis of a myxoma were included. Demographic information and data on disease extent and extraskeletal manifestations of FD/MAS such as precocious puberty (PP) or café-au-lait patches (CAL) were retrieved from patient's medical records. Thirty MZB patients were included: 20 women (67%) and 10 men (33%). Patients received a diagnosis of MZB (median 42 years, range 16-19) significantly later than the diagnosis of FD/MAS (median 30 years, range 0-60), p < 0.01. Twenty-six patients were diagnosed with polyostotic disease (87%). In 97% the myxoma was located near the skeletal FD lesion. The combination of MZB and MAS was made in 13 patients in whom PP (n = 7), CAL (n = 7), GH-excess (n = 3) and hyperthyroidism (n = 3) were present. Other extraskeletal features were (multinodular) goiter (n = 2) and thyroid cysts (n = 1). Furthermore, in this cohort of patients with MZB several (pre-)malignant tumors were observed; ductal carcinoma in situ of the breast in 3 patients (10%), breast cancer in 1 patient (3.3%), intra pancreatic mucinous neoplasms in 3 patients (10%) and liver adenomas in 2 patients (6.6%). A total of 47% of patients with MZB had an additional extraskeletal feature such as an endocrinopathy. In MZB, 87% of patients suffer from polyostotic FD, 43% of patients have extraskeletal GNAS-features such as an hyperfunctioning endocrinopathy and 30% (pre-)malignant tumors. We therefore advocate that MZB patients should undergo a complete screening and long-term follow-up for extent of bone disease, but also extraskeletal GNAS features of FD/MAS.
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Affiliation(s)
- M Hagelstein-Rotman
- Department of Medicine: Division of Endocrinology, Centre for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands.
- Department of Orthopaedic Surgery, Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - N M Appelman-Dijkstra
- Department of Medicine: Division of Endocrinology, Centre for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands
| | - A M Boyce
- Skeletal Disorders and Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - R Chapurlat
- UMR 1033, INSERM, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - N B J Dur
- Department of Orthopaedic Surgery, Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - D Gensburger
- UMR 1033, INSERM, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - B C J Majoor
- Department of Orthopaedic Surgery, Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - M A J van de Sande
- Department of Orthopaedic Surgery, Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - P D S Dijkstra
- Department of Orthopaedic Surgery, Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
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Pankratjevaite L, Christensen LF, Pranckevicius T, Razbadauskiene S. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac145. [PMID: 35422994 PMCID: PMC9004476 DOI: 10.1093/jscr/rjac145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Intramuscular myxoma (IM) is a rare benign tumour. It may occur at any age but most commonly occurs among older women. The preoperative diagnosis of IM is complicated. The diagnosis can only be definitively established by histopathological examination. The treatment of choice is radical surgical excision. We report a case of a 41-year-old woman with an IM of the biceps brachii muscle.
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Affiliation(s)
- Lina Pankratjevaite
- Department of Breast Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Breast Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Louise Fischer Christensen
- Correspondence address. Department of Ophthalmology, Aalborg University Hospital, 9000 Aalborg, Denmark. Tel: +4526811447; E-mail:
| | - Tadas Pranckevicius
- Department of Surgery, Lithuanian University of Health Sciences Kaunas Hospital, Kaunas, Lithuania
| | - Sigita Razbadauskiene
- Department of Pathology, Lithuanian University of Health Sciences Kaunas Hospital, Kaunas, Lithuania
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Abstract
PURPOSE Intramuscular myxoma (IM) is a rare benign myxoid tumor that may be challenging to differentiate from sarcoma in small amounts of biopsied material. Although IM appears to be well-circumscribed macroscopically, it infiltrates the adjacent edematous muscle microscopically. The recommended treatment is resection, but there is controversy with regard to the appropriate surgical margin. This study aimed to clarify which surgical procedure that should be applied when the preoperative diagnosis is IM and how to manage treatment if the postoperative diagnosis turns out to be a sarcoma. METHODS We retrospectively examined 55 IM patients treated from January 1982 to December 2014. Patient characteristics, tumor location, tumor size, radiograph, preoperative and postoperative pathological reports, surgical techniques, treatment outcome, and complications were reviewed. The patients were followed up on for at least 5 years. All patients were confirmed not to have Mazabraud syndrome. RESULTS In the 55 IM patients examined, the mean patient age was 48 years and most were female. The most common tumor locations were in the muscles of the thighs (47%) and buttocks (20%). The mean tumor diameter was 5 cm. Wide resection and marginal resection were performed in 24 and 31 patients, respectively. The mean follow-up duration was 19 years. No local recurrence, malignant transformation, or complications were observed. CONCLUSIONS Marginal resection is suitable in patients whose preoperative diagnosis is IM, as it is able to prevent local recurrence and allows for the preservation of muscle and muscle fascia. If the postoperative diagnosis turns out to be myxoid sarcoma, minimum surgical contamination makes additional wide resection less invasive.
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Shi J, Dai T, Yang R, Sun Z. Diagnostic value of ultrasonography and other imaging examinations in patients with intramuscular myxoma: A case series and literature review. Clin Imaging 2020; 68:161-165. [PMID: 32623196 DOI: 10.1016/j.clinimag.2020.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 11/27/2022]
Abstract
Intramuscular myxoma (IM) is a rare benign soft tumor of mesenchymal origin. Most IMs are located in the large skeletal muscles, and they are typically painless slow-growing masses that are detected incidentally. Surgical excision of IM usually has a good prognosis. Because of its rarity, diagnosing IM via imaging modalities such as ultrasonography (US), computed tomography, positron emission tomography/computed tomography, and magnetic resonance imaging (MRI) can be challenging. Relevant literature and cases were selected as per the inclusion and exclusion criteria. Characteristic imaging findings include a well-defined, ovoid mass with regular morphology and an orientation whereby the long axis is aligned with the course of muscle fibers. In US, IMs exhibit solid cystic mixed echo without obvious blood flow signal. However, MRI reveals hypointensity on T1-weighted images and hyperintensity on T2-weighted images with mild and patchy enhancement. In cases of suspected or potential IM, US and MRI can provide excellent resolution at a reasonable cost. This report aims to improve the recognition rate of IM. Herein, we review imaging characteristics that can contribute to the differential diagnosis of IM.
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Affiliation(s)
- Jiahong Shi
- Department of Ultrasound, The Third Hospital of Jilin University, Changchun, China
| | - Ting Dai
- Department of Ultrasound, The Third Hospital of Jilin University, Changchun, China
| | - Ran Yang
- Department of Ultrasound, The Third Hospital of Jilin University, Changchun, China
| | - Zhixia Sun
- Department of Ultrasound, The Third Hospital of Jilin University, Changchun, China.
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Nisi M, Izzetti R, Gabriele M, Pucci A. Oral intramuscular myxoma: case report and brief review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:e52-e58. [PMID: 32499151 DOI: 10.1016/j.oooo.2020.03.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/13/2020] [Accepted: 03/31/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Myxomas are rare benign mesenchymal soft tissue tumors that seldom affect the head and neck area. The present report describes a rare case of intramuscular myxoma of the oral cavity and briefly reviews the literature regarding the occurrence of these lesions in the maxillofacial area. STUDY DESIGN A 59-year-old patient was referred for the development of a slow-growing tumefaction in the right buccal mucosa in the previous 12 months. Magnetic resonance imaging was performed to characterize the lesion's dimensions and its relationship with the surrounding structures, and it revealed intramuscular localization in correspondence with the medial pterygoid muscle. Incisional biopsy was carried out to aid in the final diagnosis. RESULTS Histology revealed the presence of an intramuscular myxoma, characterized by discontinuous margins and locally infiltrating muscular fibers. A second surgery was performed to totally remove the lesion. Follow-up at 6 months did not show any signs of recurrence. A literature search was performed to retrieve data on the incidence of oral intramuscular myxomas. CONCLUSIONS To the best of our knowledge, this is the first case of intramuscular myxoma of the medial pterygoid muscle reported in the literature. Although rarely encountered, intramuscular myxomas should be considered when performing differential diagnoses of soft tissue masses at the level of the masticatory muscles.
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Affiliation(s)
- Marco Nisi
- Department of Surgical Pathology, Medicine, Molecular and Critical Area, University of Pisa, Pisa, Italy.
| | - Rossana Izzetti
- Department of Surgical Pathology, Medicine, Molecular and Critical Area, University of Pisa, Pisa, Italy
| | - Mario Gabriele
- Department of Surgical Pathology, Medicine, Molecular and Critical Area, University of Pisa, Pisa, Italy
| | - Angela Pucci
- Department of Surgical Pathology, Medicine, Molecular and Critical Area, University of Pisa, Pisa, Italy
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Boyce AM, Collins MT. Fibrous Dysplasia/McCune-Albright Syndrome: A Rare, Mosaic Disease of Gα s Activation. Endocr Rev 2020; 41:5610851. [PMID: 31673695 PMCID: PMC7127130 DOI: 10.1210/endrev/bnz011] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/29/2019] [Indexed: 12/14/2022]
Abstract
Fibrous dysplasia/McCune-Albright syndrome (FD/MAS) is a rare disorder of striking complexity. It arises from somatic, gain-of-function mutations in GNAS, leading to mosaic Gα s activation and inappropriate production of intracellular cyclic adenosine monophosphate (cAMP). The clinical phenotype is largely determined by the location and extent of affected tissues, and the pathophysiological effects of Gα s activation within these tissues. In bone, Gα s activation results in impaired differentiation of skeletal stem cells, leading to discrete skeletal lesions prone to fracture, deformity, and pain. Extraskeletal manifestations include a variable combination of hyperpigmented macules and hyperfunctioning endocrinopathies. Distinctive age-related changes in disease development has key effects on histologic, radiographic, and clinical features. FD/MAS thus presents along a uniquely broad clinical spectrum, and the resulting challenges in diagnosis and management can be difficult for clinicians. This review presents FD/MAS in the context of a mosaic disorder of Gα s activation, providing an intellectual framework within which to understand, evaluate, and treat this interesting disease. It includes a comprehensive summary of current understanding of FD/MAS pathogenesis, and a detailed discussion of clinical presentation and management. Critical areas of unmet need are highlighted, including discussion of key challenges and potential solutions to advance research and clinical care in FD/MAS.
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Affiliation(s)
- Alison M Boyce
- Skeletal Disorders and Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
| | - Michael T Collins
- Skeletal Disorders and Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
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Custódio M, Antunes E, Alves G, Braz-Silva P. Unexpected diagnosis of an intramuscular myxoma arising from the masseter muscle. Br J Oral Maxillofac Surg 2020; 58:109-111. [DOI: 10.1016/j.bjoms.2019.10.317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/30/2019] [Indexed: 11/24/2022]
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Adamonis S, Enodien B, Taha‐Mehlitz S, Maurer A, Taha A. Intramuscular myxoma of the deltoid muscle in a swimmer: A rare case report and literature review. Clin Case Rep 2019; 7:2398-2401. [PMID: 31893067 PMCID: PMC6935645 DOI: 10.1002/ccr3.2483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/04/2019] [Accepted: 08/27/2019] [Indexed: 11/05/2022] Open
Abstract
Intramuscular myxoma (IM) is a rare mesenchymal neoplasm with the incidence of one per 1 000 000 people and is reported greater among women. Our case reports an IM of a deltoid muscle in a young man. Differential diagnosis with sarcoma is important. Surgery is the treatment of choice usually without recurrence.
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Affiliation(s)
- Saulius Adamonis
- Clinic for General and Visceral SurgerySpital EinsiedelnEinsiedelnSwitzerland
| | - Bassey Enodien
- Department of General SurgeryGZO Spital WetzikonWetzikonSwitzerland
| | | | - Andreas Maurer
- Department of Orthopedics and Trauma SurgeryRheinfelden HospitalRheinfeldenSwitzerland
| | - Anas Taha
- Department of Visceral and Thoracic SurgeryCantonal Hospital of WinterthurWinterthurSwitzerland
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A Rare Case of Supinator Intramuscular Myxoma with Encasement of the Posterior Interosseous Nerve. Case Rep Orthop 2019; 2019:5156032. [PMID: 31485364 PMCID: PMC6710791 DOI: 10.1155/2019/5156032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 11/25/2022] Open
Abstract
Intramuscular myxomas are rare, benign mesenchymal tumors. Tumor location in the forearm is very rare among all the intramuscular myxomas. To the best of our knowledge, there were two cases of supinator intramuscular myxoma reported in the literature, and we intend to report the third case of supinator myxoma with encasement of the posterior interosseous nerve (PIN). A 67-year-old lady presented with history of left proximal forearm swelling for the past 5 years. Magnetic resonance imaging showed a lobulated multiseptated lesion seen within left supinator muscle, which was hyperintense on T2-weighted images (T2WI) and hypointense on T1-weighted images (T1WI), with peripheral enhancement post contrast. The tissue diagnosis of myxoma was confirmed via an open biopsy. She underwent en bloc resection of the tumor. The PIN was encased by the tumor; it was preserved and carefully released from the tumor. The nerve sheath served as an excision margin. In conclusion, we present a rare case of an intramuscular myxoma in the supinator muscle. In view of the location, extra attention should be paid during excision surgery to locate the PIN and to avoid damaging the surrounding structures.
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Belzarena AC, Wright M, Joyce DM. A case of a myxoma within the obturator externus muscle. Radiol Case Rep 2019; 14:872-875. [PMID: 31193120 PMCID: PMC6517614 DOI: 10.1016/j.radcr.2019.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 04/27/2019] [Accepted: 04/27/2019] [Indexed: 12/29/2022] Open
Abstract
Intramuscular myxomas (IM) are rare benign tumors of mesenchymal origin. These tumors have a high myxoid content and a nonspecific radiologic appearance. Here we describe the case of a patient with an IM in an infrequent location; within the obturator externus muscle. A singular approach was utilized for the resection of this tumor in such rare location. Despite IM being benign tumors, patients may require a surgical excision due to the difficulty of differentiating these tumors, with unreliable imaging features, from other myxoid soft tissue masses.
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Affiliation(s)
- Ana C Belzarena
- Moffitt Cancer Center, 12902 Magnolia Dr., Tampa, FL 33612, USA
| | - Michael Wright
- Moffitt Cancer Center, 12902 Magnolia Dr., Tampa, FL 33612, USA
| | - David M Joyce
- Moffitt Cancer Center, 12902 Magnolia Dr., Tampa, FL 33612, USA
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Nonaka T, Sonohata M, Takeshita S, Oba Y, Fujii Y, Mawatari M. Intramuscular Myxoma in the Supinator Muscle with Transient Postoperative Posterior Interosseous Nerve Palsy: A Case Report. Open Orthop J 2018; 12:353-357. [PMID: 30288189 PMCID: PMC6142668 DOI: 10.2174/1874325001812010353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 11/25/2022] Open
Abstract
Background: Intramuscular myxomas are rare, benign mesenchymal tumors in the musculoskeletal system, and usually, the tumors arise in the large muscles of the thigh, buttocks, shoulder, and upper arm. However, a tumor of the forearm is very rare. Herein, we describe the case of an intramuscular myxoma in the supinator muscle of a 56-year-old female patient. Case Presentation: Magnetic resonance imaging showed a well-defined mass that was hypointense with the peritumoral fat ring sign. The differential diagnoses might have been myxoma, schwannoma, or intramuscular hemangioma. The histopathological image showed abundant myxoid tissue, hypocellularity, and poor vascularization. The cells of the tumor were spindle and stellate-shaped with normochromic nuclei. Based on these findings, the pathological diagnosis was an intramuscular myxoma. After excising the tumor, the patient had transient posterior interosseous nerve palsy. Conclusion: This tumor is curative by resection in toto; however, when the tumor exists in the forearm, surgeons should be careful to avoid damaging surrounding tissues because the tumor is very hard and relatively large compared to the forearm.
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Affiliation(s)
- Toshihiro Nonaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Shuhei Takeshita
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Yosuke Oba
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Yoshimasa Fujii
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
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Grande R, Ossola P, Ferrer C, Venturini L, Bononi M, Della Rocca C, di Marzo L. Spontaneous Deep Femoral Artery False Aneurysm Simulating a Neoplasm: A Rare Case and Literature Review. Ann Vasc Surg 2018. [PMID: 29518517 DOI: 10.1016/j.avsg.2018.01.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 70-year-old woman presented to our attention with a painless pulsating mass at the level of the upper left thigh without any previous history of trauma, arterial surgery, or puncture of the femoral artery. Duplex ultrasound showed a nodular angiomatous-like formation with deep venous compression; computed tomographic angiography and magnetic resonance imaging reported the presence of capsulated lesion vascularized by muscular branch of deep femoral artery (DFA). The patient underwent surgical excision of a very rare thrombized DFA branch false aneurysm. Spontaneous DFA false aneurysm, although rare, will be considered in absence of trauma or vascular catheterization or previous aneurysmal rupture.
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Affiliation(s)
- Raffaele Grande
- Department of Surgery "PietroValdoni", "Sapienza" University, Rome, Italy.
| | - Paolo Ossola
- Department of Surgery "PietroValdoni", "Sapienza" University, Rome, Italy
| | - Ciro Ferrer
- Department of Surgery "PietroValdoni", "Sapienza" University, Rome, Italy
| | - Luigi Venturini
- Department of Surgery "PietroValdoni", "Sapienza" University, Rome, Italy
| | - Marco Bononi
- Department of Surgery "PietroValdoni", "Sapienza" University, Rome, Italy
| | - Carlo Della Rocca
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University, Rome, Italy
| | - Luca di Marzo
- Department of Surgery "PietroValdoni", "Sapienza" University, Rome, Italy
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