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Hipólito-Reis J, Roque D, Teixeira JC. Lumbar paraspinal intramuscular myxoma: A case report. Surg Neurol Int 2023; 14:86. [PMID: 37025538 PMCID: PMC10070254 DOI: 10.25259/sni_141_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
Background:
With an estimated incidence of about 1 case/million patients, paravertebral intramuscular myxomas represent a rare cause of lumbar pain. Rather, they typically occur in the heart and in bone tissues.
Case Description:
A 64-year-old female presented with a protracted course of nocturnal lumbar pain that radiated to the anterior aspect of the right thigh accompanied by numbness. She reported a slow-growing right paramedian lumbar mass in the previous months. The magnetic resonance (MR) showed a right lumbar paravertebral intramuscular mass at the L3 level (i.e., 70 × 50 mm) that had well-defined margins, and markedly enhanced with gadolinium. Following gross total “en bloc” tumor resection, the patient fully recovered. Pathologically, the myofibroblastic lesion proved to be an intramuscular myxoma without malignant changes.
Conclusion:
A 64-year-old female presented with a slow-growing MR-documented right paramedian lumbar L3 mass responsible for proximal right-thigh numbness. Following “en bloc” gross total removal of the benign intramuscular myxoma, the patient was asymptomatic.
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Affiliation(s)
| | - Diogo Roque
- Department of Neurosurgery, Hospital de Santa Maria, Lisbon,
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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.
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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
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Al Awadhi A, Benichi S, Lot G, Rogers A. A case of intramuscular lumbar myxoma: Uncertainty in the preoperative diagnosis of a spinal soft tissue tumour. Neurochirurgie 2021; 68:530-534. [PMID: 34537211 DOI: 10.1016/j.neuchi.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 11/15/2022]
Abstract
We report an uncommon case of a 76-year-old woman who presented with lower back pain, an intermittent L5 radiculopathy and a right palpable paraspinal mass. Imaging studies revealed a 7-cm lumbar paraspinal pseudo-cystic soft tissue tumour developed in the paravertebral musculature, without a clear radiological diagnosis. Gross total surgical resection was performed, resulting in complete resolution of pain. Histopathological studies revealed an intramuscular (IM) myxoma. With a low positive predictive value of radiological work-up and a poor yield of percutaneous biopsies, surgery remains the mainstay treatment for these rare soft tissue tumours of the lumbar spine. Intramuscular myxomas show excellent postoperative results.
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Affiliation(s)
- A Al Awadhi
- Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Service de Neurochirurgie, 29, rue Manin, 75019 Paris, France.
| | - S Benichi
- Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Service de Neurochirurgie, 29, rue Manin, 75019 Paris, France
| | - G Lot
- Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Service de Neurochirurgie, 29, rue Manin, 75019 Paris, France
| | - A Rogers
- Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Service de Neurochirurgie, 29, rue Manin, 75019 Paris, France
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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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Domino JS, Weindel S, Woodrow S. Multiple paraspinal intramuscular myxomas: case report. J Neurosurg Spine 2019; 32:519-522. [PMID: 31783350 DOI: 10.3171/2019.9.spine19599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/16/2019] [Indexed: 11/06/2022]
Abstract
Intramuscular myxomas (IMMs) are rare benign tumors of mesenchymal origin that are most often located in large skeletal muscles, particularly of the thigh. They have also been reported within the paraspinal musculature and should be considered in the differential diagnosis of a paraspinal mass. These lesions can cause neurological symptoms due to mass effect. This is a report of a 52-year-old man with multiple paraspinal tumors that exhibited concerning growth on serial imaging studies. To the authors' knowledge, this represents the first report of a patient with multiple paraspinal myxomas. CT-guided biopsy followed by surgical excision of the largest mass was performed. Histopathological analysis was consistent with an IMM. Patients with multiple IMMs often have an underlying genetic syndrome such as Mazabraud syndrome, McCune-Albright syndrome, or Carney complex. Despite variable growth patterns and associations with genetic syndromes, multiple IMMs have had no documented cases of malignant transformation into myxoid sarcoma; therefore, surgical excision should be considered based on a patient's individual symptoms.
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Affiliation(s)
| | - Shane Weindel
- 2Pathology, University of Kansas Medical Center, Kansas City, Kansas
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Rare Hypothenar Myxoma Causing Ulnar Neuropathy: Histopathology and Treatment Pearls. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1806. [PMID: 30175009 PMCID: PMC6110681 DOI: 10.1097/gox.0000000000001806] [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: 11/08/2017] [Accepted: 04/11/2018] [Indexed: 12/01/2022]
Abstract
A myxoma is a neoplasm comprised of mesenchymal connective tissue. Myxomas of the upper extremity, and particularly of the hand, are rare. We present a case of a hypothenar myxoma causing ulnar neuropathy in a patient with a history of acute inflammatory demyelinating process. Treatment and management of myxoma may vary depending on whether the process is malignant or benign; thus, histologic diagnosis is critical to determining treatment. The purpose of this article is to review the pathophysiology and clinical features of myxomas, and to provide recommendations for evaluating and treating individuals with extremity masses of unclear clinical diagnosis.
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Choi DY, Kim JT, Kim J, Lee HJ. Atypical Intramuscular Myxoma of the Lumbosacral Paraspinal Muscle: The First Case Report in Asian. J Korean Neurosurg Soc 2016; 58:566-70. [PMID: 26819696 PMCID: PMC4728099 DOI: 10.3340/jkns.2015.58.6.566] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 08/18/2015] [Accepted: 09/03/2015] [Indexed: 11/27/2022] Open
Abstract
Intramuscular myxoma (IM) is a benign neoplasm of mesenchymal origin. We report a rare case of IM which was located in the lumbosacral paraspinal muscles. A 62-year-old female patient presented with progressive low back pain for 2 months, and the radiologic findings showed a large mass (4.0×3.5×6.5 cm) in the right lumbosacral paraspinal area. Total resection of the tumor was performed and the symptom was nearly resolved after surgery. Although the immuno-histopathological analysis was consistent with IM, there were some different findings from typical pathological characteristics of IM in this case. Firstly, the symptomatic change of the mass took relatively short time (less than 3 months), and this change was accompanied by partial calcification inside the mass. Moreover, iatrogenic interruption of paravertebral muscle by the other previous operation might be the promoting factor of the fibrous dysplasia, which can explain the pathogenesis of IM. To our knowledge, this is the eighth case of the lumbar paraspinal myxoma reported in the literatures and the first case in Asian population.
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Affiliation(s)
- Doo Yong Choi
- Department of Neurosurgery, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | - Jong Tae Kim
- Department of Neurosurgery, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | - Jiyoung Kim
- Department of Pathology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | - Ho Jin Lee
- Department of Neurosurgery, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
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