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Skeletal Radiology

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01-01-2005 | Scientific Article

Magnetic resonance imaging of intramuscular myxoma with histological comparison and a review of the literature

Authors: A. Luna, S. Martinez, E. Bossen

Published in: Skeletal Radiology | Issue 1/2005

Abstract

Objective

To evaluate the magnetic resonance (MR) features of intramuscular myxoma (IM) compared with its pathological findings.

Design

Two radiologists retrospectively reviewed records and imaging studies of patients with histologically proven IM. Two radiologists also analyzed by consensus all the MR studies (pre- and post-contrast T1-weighted and T2-weighted sequences) and a pathologist reviewed the available histological material.

Patients

Seventeen patients with 18 histologically proven IM were reviewed. Histological samples of 11 of these 18 tumors were available for pathological analysis.

Results

There were 14 women and three men, with a mean age of 58.9 years. IM involved predominantly the thigh (n=10). MR imaging showed well-circumscribed intramuscular masses, hypointense on T1-weighted and hyperintense on T2-weighted images. Eleven masses were homogeneous and seven slightly heterogeneous due to fibrous septa. Enhanced MR imaging demonstrated three different patterns: peripheral enhancement (n=1), peripheral and patchy internal enhancement (n=7) or peripheral and linear internal enhancement (n=4). Intratumoral cysts were detected in four masses. MR imaging showed the presence of a pseudocapsule (n=12), fat around the lesion (n=16) and peritumoral edema (n=16). Histologically, all the tumors were hypocellular, hypovascular and myxoid. Peripheral areas of collagenous fibers formed a partial capsule and IM often merged into surrounding muscular fibers. More cellular tumors and those with scanty myxoid stroma tended to show a more prominent internal enhancement.

Conclusion

IM shows several recognizable MR features which suggest its diagnosis.

Stout AP. Myxoma, the tumor of primitive mesenchyme. Ann Surg 1948; 127:706.

Ireland DCR, Soule EM, Ivins JC. Myxoma of the somatic soft tissue. Mayo Clin Proc 1973; 48:401.PubMed

Kindblom KL, Stener B, Angerball L. Intramuscular myxoma. Cancer 1974; 34:1737–1744.PubMed

McCook TA, Martinez S, Korobkin M, et al. Intramuscular myxoma. Radiographic and computed tomographic findings with pathologic correlation. Skeletal Radiol 1981; 7:15–19.PubMed

Ekelund L, Herrlin K, Rydholm A. Computed tomography of intramuscular myxoma. Skeletal Radiol 1982; 9:14–16.PubMed

Petterson H, Hudson TM, Springfield DS, Kaude JV. Cystic intramuscular myxoma. Acta Radiol Diagn 1985; 26:425–426.

Kransdorf MJ, Moser RP, Jelinek JS, Weiss SW, Benton PC, Berry BH. Intramuscular myxoma: MR features. J Comput Assist Tomogr 1989; 13:836–839.PubMed

Fornage BD, Romsdahl MM. Intramuscular myxoma: sonographic appearance and sonographically guided needle biopsy. J Ultrasound Med 1994; 13:91–94.PubMed

Kransdorf MJ, Murphey MD. Tumors of uncertain origin. In: Imaging of soft tissue tumors. Philadelphia: WB Saunders, 1997:353–357.

10.

Peterson KK, Renfrew DL, Feddersen RM, Buckwalter JA, El-Khoury GY. Magnetic resonance imaging of myxoid containing tumors. Skeletal Radiol 1991:20:245–250.

11.

Abdelwahad IF, Kenan S, Hermann G, Lewis MM, Klein MJ. Intramuscular myxoma: magnetic resonance features. Br J Radiol 1992; 65:485–490.PubMed

12.

Caraway NP, Staerkel GA, Fanning CV, Varma DG, Pollock RE. Diagnosing intramuscular myxoma by fine-needle aspiration. Diagn Cytopathol 1994; 11:255–261.PubMed

13.

Aoki T, Koulo H, Hisaoka M, Hashimoto H, Nakata H, Sakai A. Intramuscular myxoma with fibrous dysplasia: a report of two cases with review of the literature. Pathol Int 1995; 45:165–171.PubMed

14.

Ma LD, Frassica FJ, McCarthy EF, Bluemke DA, Zerhouni EA. Benign and malignant musculoskeletal masses: MR imaging differentiation with rim-to-center differential enhancement ratios. Radiology 1997; 202:739–744.PubMed

15.

Schwartz HS, Walker R. Recognizable magnetic resonance imaging characteristics of intramuscular myxoma. Orthopedics 1997; 20: 431–435.PubMed

16.

May DA, Good RB, Smith DK, Parsons TW. MR imaging of musculoskeletal tumors and tumor mimickers with intravenous gadolinium: experience with 242 patients. Skeletal Radiol 1997; 26:2–15.CrossRefPubMed

17.

Court-Payen M, Jensen LI, Bjerregaard B, Schwarz G, Skjoldbyi B. Intramuscular myxoma and fibrous dysplasia of bone: Mazabraud’s syndrome. Acta Radiol 1997; 38:368–371.PubMed

18.

Kransdorf MJ, Murphey MD. Case of the month: Mazabraud’s syndrome. Radiology 1999; 212:129–132.PubMed

19.

Kilcoyne RF, Richardson MJ, Porter BA, Olson DO, Greenlee TK, Lanzer W. Magnetic resonance imaging of soft-tissue masses. Clin Orthop 1988; 228:13–18.PubMed

20.

Totty WG, Murphy WA, Lee JKT. Soft-tissue tumors: MR imaging. Radiology 1986; 160:135–141.PubMed

21.

Moulton JS, Biebea JS, Dunco DM, Braley SE, Bisset III GS, Emery KH. MR Imaging of soft-tissue masses: diagnostic efficacy and value of distinguishing between benign and malignant lesions. AJR Am J Roentgenol 1995; 164:1191–1199.PubMed

22.

Kransdorf MJ, Jelinek JS, Moser RP, et al. Soft tissue masses: diagnosis using MR imaging. AJR Am J Roentgenol 1989; 153:541–547.PubMed

23.

Weekes RG, Berquist TH, McLeod RA, Zimmer WD. Magnetic resonance imaging of soft tissue tumors: comparison with computed tomography. Magn Reson Imaging 1985; 3:345–352.CrossRefPubMed

24.

Berquist TH, Ehman RL, King BF, Hodgman CG, Ilstrup DM. Value of MRI in differentiating benign from malignant soft tissue masses: study of 95 lesions. AJR Am J Roentgenol. 1990; 155:1251–1255.

25.

Glass-Royal MC, Nelson MC, Albert F, Lack EE, Bogumill GP. Case report 557: solitary intramuscular myxoma in a patient with polyostotic fibrous dysplasia. Skeletal Radiol 1989; 18:392–398.PubMed

26.

Gober GA, Nicholas RW. Case Report 800: skeletal fibrous dysplasia associated with intramuscular myxoma (Mazabraud’s syndrome). Skeletal Radiol 1993; 6:452–455.

27.

Lassance Cabral CE, Guedes P, Fonseca T, Rezende JF, Cruz LC, Smith J. Polyostotic fibrous dysplasia associated with intramuscular myxomas: Mazabraud’s syndrome. Skeletal Radiol 1998; 27:278–282.CrossRefPubMed

28.

Abdelwahab IF, Kenan S, Hermann G, Klein MJ, Lewis MM. Intramuscular myxoma of the left forearm. Bull Hosp Jt Dis 1993; 53(3):15–17.

29.

Kamoun N, Zouari M Siala S, et al. Myxome intra-musculaire. A propos de deux localisations. Rev Chir Orthop 1997; 83:278–282.PubMed

30.

Suzuki T, Mio A, Suzaki K, et al. An evaluation of MR imaging of soft-tissue masses in extremities. Rinsho Hoshasen 1990; 35: 69–75.PubMed

31.

Enzinger FM. Intramuscular myxoma: a review and follow-up study of 34 cases. Am J Clin Pathol 1965; 43:104–113.PubMed

32.

Walker RE, Schwartz RK, Gale DR. Musculoskeletal case of the day. Mazabraud’s syndrome (intramuscular myxoma associated with fibrous dysplasia of bone). AJR Am J Roentgenol 1999; 173:797, 800–802.PubMed

33.

Struk DW, Munk PL, Lee MJ. Musculoskeletal case 8: Mazabraud’s syndrome—intramuscular myxoma associated with fibrous dysplasia. Can J Surg 2000; 43:62–63.

34.

Guppy KH, Wagner F, Tawk R, Gallagher L. Intramuscular myxoma causing lumbar radiculopathy. Case report and review of the literature. Neurosurgery 2001; 95(2 Suppl):260–263.

35.

Delabrousse E, Couvreur M, Bartholomot B, Lucas X, Kastler B. Mazabraud syndrome: a case diagnosed with MRI. J Radiol 2001; 82:165–167.PubMed

36.

Iwasko N, Steinbach LS, Disler D, et al. Imaging findings in Mazabraud’s syndrome: seven new cases. Skeletal Radiol 2002; 31:81–87.CrossRefPubMed

37.

Bancroft LW, Kransdorf MJ, Menke DM, O’Connor MI, Foster WC. Intramuscular myxoma. Characteristic MR imaging features. AJR Am J Roentgenol 2002; 178:1255–1259.PubMed

38.

Murphey MD, McRae GA, Fanburg-Smith JC, Temple T, Levine AM, Aboulafia AJ. Imaging of soft tissue myxoma with emphasis on CT and MR and comparison of radiological and pathologic findings. Radiology 2002; 225:215–224.CrossRefPubMed

39.

Silver WP, Harrelson JM, Scully SP. Intramuscular myxoma: a clinico-pathological study of 17 patients. Clin Orthop 2002; 403:191–197.PubMed

40.

Ly JQ, Bau JL, Beall DP. Forearm intramuscular myxoma. AJR Am J Roentgenol 2003; 181:960.PubMed

41.

Nishimoto K, Kusuzaki K, Matsumine A, et al. Surrounding muscle edema detected by MRI is valuable for diagnosis of intramuscular myxoma. Oncol Rep 2004;11:143–148.PubMed

42.

Nielsen GP, O’Conell JX, Rosenberg AE. Intramuscular myxoma: a clinicopathological study of 51 cases with emphasis on hypercellular and hypervascular variants. Am J Surg Pathol 1998; 22: 1222–1227.CrossRefPubMed

43.

Enzinger FM, Weiss SW. Benign soft tissue tumors of uncertain type. In: Enzinger FM, Weiss SW. Soft tissue tumors, 3rd edn. St Louis: Mosby, 1994:1045–1051.

44.

Henschen F. Fall von Ostitis fibrosa mit multiplen Tumoren in der umgebeden Muskulature. Verh Dtsch Ges Pathol 1926; 21:93.

45.

Mazabraud A, Semat P, Rose R. A propos de l’association de fibromixomes des tissus mous à la dysplasie fibreuse des os. Presse Med 1967; 75:2223–2228.PubMed

46.

Logel RJ. Recurrent intramuscular myxoma associated with Albright’s syndrome J Bone Joint Surg Am 1976; 58:565–568.

47.

Lever EG, Pettingale RW. Albright’s syndrome associated with a soft tissue myxoma and hypophosphatemic osteomalacia: report of a case and a review of the literature. J Bone Joint Surg Br 1983; 65:621–626.PubMed

48.

Witkin GB, Guildford WB, Siegal GP. Osteogenic sarcoma and soft tissue myxoma in a patient with fibrous dysplasia and hemoglobins J Baltimore and S. Clin Orthop 1986; 204:245–252.PubMed

49.

Wirth A, Leavitt D, Enzinger FM. Multiple intramuscular myxomas: another extraskeletal manifestation of fibrous dysplasia. Cancer 1971; 27:1167–1173.PubMed

50.

Berkhoff WBC, ter Bruggen Hugenholtz RI, Ingenhoes R. A patient with multiple intramuscular myxomas with fibrous dysplasia. Ned Tijdschr Geneskd 1981; 125:1460–1462.

51.

Sedmark DD, Hart WR, Bellhobek GH, Marks KE. Massive intramuscular myxoma associated with fibrous dysplasia of bone. Cleve Clin Q 1983; 50:469–472.PubMed

52.

Segev Z, Reiner S. Intramuscular myxoma associated with fibrous dysplasia. Harefuah 1985; 16:493–494.

53.

Biagini R, Ruggieri P, Boriani S, Picci P. The Mazabraud’s syndrome: case report and review of the literature. Ital J Orthop Traumatol 1987; 1:105–111.

54.

Sundaram M, McDonald DJ, Merenda G. Intramuscular myxoma: a rare but important association with fibrous dysplasia of bone. AJR Am J Roentgenol 1989; 153:107–108.PubMed

55.

Gianoutsos MP, Thompson JF, Marsden FW. Mazabraud’s syndrome: intramuscular myxoma associated with fibrous dysplasia of bone. Aust N Z J Surg 1990; 10:825–828.

56.

Fujii K, Inove M, Araki Y, Ishida O. Multiple intramuscular myxomas associated with polyostotic fibrous dysplasia. Eur J Radiol 1996; 2:152–154.CrossRef

57.

Limouzy F, Durroux R, Chiron P, Tricoire JL, Puget J, Utheza G. Fibrous dysplasia associated with intramuscular myxoma. Rev Chir Orthop Repartrice Appar Mot 1996; 82:336–339.

58.

Prayson MA, Leeson MC. Soft-tissue myxomas and fibrous dysplasia of bone. Clin Orthop 1993; 291:222–228.PubMed

59.

Rodenberg J, Jensen OM, Keller J, Nielsen OS, Bunger C, Jurik AG. Fibrous dysplasia of the spine, costal and hemipelvis with sarcomatous transformation. Skeletal Radiol 1996; 25:665–684.CrossRef

60.

Lopez-Ben R, Pitt MJ, Jaffe KA, Siegal GP. Osteosarcoma in a patient with McCune-Albright syndrome and Mazabraud’s syndrome. Skeletal Radiol 1999; 28:522–526.CrossRefPubMed

61.

Parisi B, Cavallera A, Cerrone M, Pecoraro C, Del Viscovo L. Mazabraud’s síndrome. A case report. Radiol Med (Torino). 1999; 98:405–407.

62.

Faivre L, Nivelon-Chevalier A, Kottler ML, et al. Mazabraud syndrome in two patients: clinical overlap with McCune-Albright syndrome. Am J Med Genet 2001; 99:132–136.

63.

Pollandt K, Lohmann CH, Werner M, et al. Clinical pathological aspects of Mazabraud’s syndrome. Pathologe 2002; 23:357–360.CrossRefPubMed

64.

van Roggen JF, Hogendoorn PCW, Fletcher CDM. Myxoid tumors of soft tissues. Histopathology 1999; 35:291–312.CrossRefPubMed

65.

Murphey MD, Smith WS, Smith SE, Kransdorf MJ, Temple HT. From the archives of the AFIP. Imaging of musculoskeletal neurogenic tumors: radiologic-pathologic correlation. Radiographics 1999;19:1253–1280.PubMed

66.

Murphey MD, Walker EA, Wilson AJ, et al. Imaging of primary chondrosarcoma: radiologic-pathologic correlation. Radiographics 2003; 23:1245–1278.PubMed

67.

Sundaram M, Baran G, Merenda G, McDonald DJ. Myxoid liposarcomas: magnetic resonance imaging appearances with clinical and histological correlation. Skeletal Radiol 1990; 19:359–362.CrossRefPubMed

68.

Jelinek JS, Kransdorf MJ, Schomookler BM, Aboufalia AJ, Malawer MM. Liposarcoma of the extremities: MR and CT findings in the histologic subtypes. Radiology 1993; 186:455–459.PubMed

69.

Arkun R, Memis A, Akalin T, Ustun EE, Sabah D, Kandiloglu G. Liposarcoma of soft tissue: MRI findings with pathologic correlation. Skeletal Radiol 1997; 26:167–172.CrossRefPubMed

70.

London J, Kim E, Wallace S, Shirkoda A, Coan J, Evans H. MR imaging of liposarcomas: correlation of MR features and histology. J Comput Assist Tomogr 1989; 13:832–835.PubMed

71.

Marques MC, Garcia H. Lipomatous tumors. In: Soft tissue tumors imaging. Berlin Heidelberg New York: Springer, 1997:191–208.

72.

Miller TT, Hermann G, Abdelwahab IF, Klein MJ, Kenan S, Lewis MM. MRI of malignant fibrous histiocytoma of soft tissue: analysis of 13 cases with pathologic correlation. Skeletal Radiol 1994; 23:271–275.PubMed

73.

Murphey MD, Gross TM, Rosenthal HG. Musculoskeletal malignant fibrous histiocytoma: radiopathological correlation. Radiographics 1994; 14:807–826.PubMed

Title: Magnetic resonance imaging of intramuscular myxoma with histological comparison and a review of the literature
Authors: A. Luna
S. Martinez
E. Bossen
Publication date: 01-01-2005
Publisher: Springer-Verlag
Published in: Skeletal Radiology / Issue 1/2005
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-004-0848-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Magnetic resonance imaging of intramuscular myxoma with histological comparison and a review of the literature

Abstract

Objective

Design

Patients

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Design

Patients

Results

Conclusion

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