1
|
Patel S, Suji T, Pang G, Alg VS, Visagan R, Reisz Z, Lavrador JP, Kailaya-Vasan A, Grahovac G. Spinal myxomas: review of a rare entity. J Surg Case Rep 2022; 2022:rjac221. [PMID: 35665391 PMCID: PMC9156026 DOI: 10.1093/jscr/rjac221] [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: 03/23/2022] [Indexed: 11/12/2022] Open
Abstract
Intramuscular myxomas are rare, benign mesenchymal tumours, occurring predominantly in large skeletal muscles as large, slow-growing and painless masses. Spinal occurrence is rare, and may present incidentally, or diagnosed via localized symptoms secondary to local infiltration of surrounding structures. Differential diagnosis based on imaging includes sarcomas, meningiomas and lipomas. We discuss two contrasting cases presenting with well-circumscribed cystic paraspinal lesions indicative of an infiltrative tumour and discuss the radiological and histological differences that distinguish myxomas from similar tumours. Surgical resection of the tumour was performed in both cases, however one patient required surgical fixation due to bony erosion secondary to tumour infiltration. Immuno-histopathological analysis confirmed the diagnosis of a cellular myxoma. Follow up imaging at 6 months confirmed no symptomatic or tumour recurrence in both cases. Histological analysis is the definitive means for diagnosis to differentiate myxomas from other tumours. Recurrence is rare if full resection is achieved.
Collapse
Affiliation(s)
- Sabina Patel
- King's Neuro Lab, Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Graeme Pang
- King's Neuro Lab, Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Varinder S Alg
- King's Neuro Lab, Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Ravindran Visagan
- King's Neuro Lab, Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Zita Reisz
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,Department of Neuropathology, King's College Hospital NHS Foundation Trust, London, UK
| | - Jose P Lavrador
- King's Neuro Lab, Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Ahilan Kailaya-Vasan
- King's Neuro Lab, Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Gordan Grahovac
- King's Neuro Lab, Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
2
|
Xu F, Jin Y, Li Q, Dong F, Lu L, Cui Q, Wang C. Intradural Extramedullary Nerve Sheath Myxoma of the Cervical Spine: A Case Report and Review of Literature. Front Surg 2022; 8:722254. [PMID: 35071307 PMCID: PMC8776648 DOI: 10.3389/fsurg.2021.722254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Nerve sheath myxoma is a rare benign soft tissue tumor. Intraspinal nerve sheath myxomas are rare. Only 8 cases of intraspinal nerve sheath myxoma have been reported to date, and no case of nerve sheath myxoma has been reported in the cervical spinal canal. Herein, we reported the first case of intradural extramedullary nerve sheath myxoma in the cervical spinal canal of a 57-year-old man, including its complete clinical course and radiological findings. Case Presentation: A 57-year-old male patient presented with numbness in his left finger without any obvious inducement for 3 years. CT and contrast-enhanced magnetic resonance imaging (MRI) of the spine were performed. Based on the radiological examinations, a diagnosis of schwannoma was initially made. However, nerve sheath myxoma was finally confirmed by histopathological and immunohistochemical examinations. Complete tumor excision at the C1-2 level was performed. Then, the patient recovered well, and the numbness of his left finger disappeared during the later follow-up after the surgery. Conclusion: Nerve sheath myxoma should receive diagnostic consideration for an extramedullary subdural lesion that is a clear boundary mass characterized by isointensity on T1-weighted images, heterogeneous intensity on T2-weighted images, obvious peripheral enhancement, and a growing tendency toward the intervertebral foramen.
Collapse
Affiliation(s)
- Fangfang Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Jin
- Department of Rehabilitation in Traditional Chinese Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qian Li
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fei Dong
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liangji Lu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qingfeng Cui
- Department of Rehabilitation in Traditional Chinese Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chao Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Chao Wang
| |
Collapse
|
3
|
Röhrich M, Koelsche C, Schrimpf D, Capper D, Sahm F, Kratz A, Reuss J, Hovestadt V, Jones DTW, Bewerunge-Hudler M, Becker A, Weis J, Mawrin C, Mittelbronn M, Perry A, Mautner VF, Mechtersheimer G, Hartmann C, Okuducu AF, Arp M, Seiz-Rosenhagen M, Hänggi D, Heim S, Paulus W, Schittenhelm J, Ahmadi R, Herold-Mende C, Unterberg A, Pfister SM, von Deimling A, Reuss DE. Methylation-based classification of benign and malignant peripheral nerve sheath tumors. Acta Neuropathol 2016; 131:877-87. [PMID: 26857854 DOI: 10.1007/s00401-016-1540-6] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/22/2016] [Accepted: 01/24/2016] [Indexed: 12/20/2022]
Abstract
The vast majority of peripheral nerve sheath tumors derive from the Schwann cell lineage and comprise diverse histological entities ranging from benign schwannomas and neurofibromas to high-grade malignant peripheral nerve sheath tumors (MPNST), each with several variants. There is increasing evidence for methylation profiling being able to delineate biologically relevant tumor groups even within the same cellular lineage. Therefore, we used DNA methylation arrays for methylome- and chromosomal profile-based characterization of 171 peripheral nerve sheath tumors. We analyzed 28 conventional high-grade MPNST, three malignant Triton tumors, six low-grade MPNST, four epithelioid MPNST, 33 neurofibromas (15 dermal, 8 intraneural, 10 plexiform), six atypical neurofibromas, 43 schwannomas (including 5 NF2 and 5 schwannomatosis associated cases), 11 cellular schwannomas, 10 melanotic schwannomas, 7 neurofibroma/schwannoma hybrid tumors, 10 nerve sheath myxomas and 10 ganglioneuromas. Schwannomas formed different epigenomic subgroups including a vestibular schwannoma subgroup. Cellular schwannomas were not distinct from conventional schwannomas. Nerve sheath myxomas and neurofibroma/schwannoma hybrid tumors were most similar to schwannomas. Dermal, intraneural and plexiform neurofibromas as well as ganglioneuromas all showed distinct methylation profiles. Atypical neurofibromas and low-grade MPNST were indistinguishable with a common methylation profile and frequent losses of CDKN2A. Epigenomic analysis finds two groups of conventional high-grade MPNST sharing a frequent loss of neurofibromin. The larger of the two groups shows an additional loss of trimethylation of histone H3 at lysine 27 (H3K27me3). The smaller one retains H3K27me3 and is found in spinal locations. Sporadic MPNST with retained neurofibromin expression did not form an epigenetic group and most cases could be reclassified as cellular schwannomas or soft tissue sarcomas. Widespread immunohistochemical loss of H3K27me3 was exclusively seen in MPNST of the main methylation cluster, which defines it as an additional useful marker for the differentiation of cellular schwannoma and MPNST.
Collapse
Affiliation(s)
- Manuel Röhrich
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Koelsche
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Schrimpf
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Capper
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annekathrin Kratz
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jana Reuss
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Hovestadt
- Division of Molecular Genetics, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melanie Bewerunge-Hudler
- Genomics and Proteomics Core Facility, Microarray Unit, German Cancer Research Center (DKFZ), INF 580, Heidelberg, Germany
| | - Albert Becker
- Institute of Neuropathology, University Medical Center, Bonn, Germany
| | - Joachim Weis
- Institute of Neuropathology, Rheinisch-Westfälische Technische Hochschule, Aachen University Hospital, Aachen, Germany
| | - Christian Mawrin
- Department of Neuropathology, Otto-von-Guericke University, Magdeburg, Germany
| | - Michel Mittelbronn
- Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Arie Perry
- Division of Neuropathology, University of California, San Francisco, USA
| | - Victor-Felix Mautner
- Department of Neurology, University Hospital Hamburg Eppendorf, 20246, Hamburg, Germany
| | - Gunhild Mechtersheimer
- Department of General Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Christian Hartmann
- Department of Neuropathology, Hannover Medical School, Hannover, Germany
| | - Ali Fuat Okuducu
- Department of Pathology, Municipal Hospital Nürnberg, Nuremberg, Germany
| | - Mirko Arp
- Department of Neurosurgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefanie Heim
- Institute of Neuropathology, University Hospital, Muenster, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital, Muenster, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, University Hospital, Tuebingen, Germany
| | - Rezvan Ahmadi
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | | | - Andreas Unterberg
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Medical Center, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David E Reuss
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany.
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
| |
Collapse
|