Imaging of Soft-Tissue Myxoma with Emphasis on CT and MR and Comparison of Radiologic and Pathologic Findings
Abstract
PURPOSE: To determine the imaging characteristics of soft-tissue myxoma, with emphasis on computed tomographic (CT) and magnetic resonance (MR) imaging findings and pathologic comparison.
MATERIALS AND METHODS: Records of 45 pathologically confirmed soft-tissue myxomas in 44 patients were retrospectively reviewed. Patient demographics and radiographs (n = 20), bone scintigrams (n = 2), angiograms (n = 3), and ultrasonographic (US) (n = 6), CT (n = 14), and MR images (n = 33) were evaluated by two musculoskeletal radiologists with agreement by consensus for lesion location, lesion size, and intrinsic characteristics.
RESULTS: Soft-tissue myxoma more commonly affected women (59%; average age 52 years) and manifested as a slowly enlarging (64%) painful (51%) mass. Lesions were most frequently intramuscular (82%) and involved the thigh (51%). An appearance similar to that of a cyst was seen at CT (at which the lesions demonstrated low attenuation) and at MR imaging (at which the lesions demonstrated markedly high signal intensity on T2-weighted images) in all cases because of the high water content of mucin that was seen histologically. The true solid architecture of these lesions was best depicted in all cases at US (at which the lesions were hypoechoic, not anechoic) and on MR images obtained with contrast material (at which the lesions demonstrated internal enhancement). A small amount of tissue similar to fat surrounding these intramuscular myxomas (71% at MR imaging) corresponded histologically (70%) to atrophy of surrounding muscle.
CONCLUSION: Soft-tissue myxoma often demonstrates characteristic US, CT, and MR imaging findings, including intramuscular location, intrinsic high water content, and a surrounding rim of fat.
References
- 1 Virchow RLK. Cellular pathology as based upon physiological and pathological histology Philadelphia, Pa: Lippincott, 1863; 525-526.
- 2 Stout A. Myxoma: the tumor of primitive mesenchyme. Ann Surg 1948; 127:706-719.
- 3 Enzinger FM, Weiss SW. Soft tissue tumors. In: Weiss SW, Goldblum JR, eds. Benign soft tissue tumors and pseudotumors of miscellaneous type. 4th ed. St Louis, Mo: Mosby, 2001; 1425-1436.
- 4 Enzinger FM. Intramuscular myxoma: a review and follow-up study of 34 cases. Am J Clin Pathol 1965; 43:104-113.
- 5 Meis JM, Enzinger FM. Juxta-articular myxoma: a clinical and pathologic study of 65 cases. Hum Pathol 1992; 23:639-646.
- 6 Ireland D, Soule E, Ivins J. Myxoma of somatic soft tissues: a report of 58 patients, 3 with multiple tumors and fibrous dysplasia of bone. Mayo Clin Proc 1973; 48:401-410.
- 7 Hashimoto H, Tsuneyoshi M, Daimaru Y, Enjoji M, Shinohara N. Intramuscular myxoma: a clinicopathologic, immunohistochemical, and electron microscopic study. Cancer 1986; 58:740-747.
- 8 Kindblom LG, Stener B, Angervall L. Intramuscular myxoma. Cancer 1974; 34:1737-1744.
- 9 Miettinen M, Hockerstedt K, Reitamo J, Totterman S. Intramuscular myxoma: a clinicopathological study of twenty-three cases. Am J Clin Pathol 1985; 84:265-272.
- 10 Abdelwahab AF, Kenan S, Hermann G, Lewis MM, Klein MJ. Intramuscular myxoma: magnetic resonance features. Br J Radiol 1992; 65:485-490.
- 11 Jimenez T, Cintron E. Intramuscular myxoma simulating a cystic mass on computed tomography. Orthopedics 1988; 11:721- 722.
- 12 King DG, Saifuddin A, Preston HV, Hardy GJ, Reeves BF. Magnetic resonance imaging of juxta-articular myxoma. Skeletal Radiol 1995; 24:145-147.
- 13 Kransdorf MJ, Moser RP, Jelinek JS, Weiss SW, Buetow PC, Berrey BH. Intramuscular myxoma: MR features. J Comput Assist Tomogr 1989; 13:836-839.
- 14 Lindahl S, Markhede G, Berlin O. Computed tomography of lipomatous and myxoid tumors. Acta Radiol Diagn (Stockh) 1985; 26:709-713.
- 15 McCook TA, Martinez S, Korobkin M, et al. Intramuscular myxoma: radiographic and computed tomographic findings with pathologic correlation. Skeletal Radiol 1981; 7:15-19.
- 16 Peterson KK, Renfrew DL, Feddersen RM, Buckwalter JA, el-Khoury GY. Magnetic resonance imaging of myxoid containing tumors. Skeletal Radiol 1991; 20:245- 250.
- 17 Pettersson H, Hudson TM, Springfield DS, Kaude JV. Cystic intramuscular myxoma: report of a case. Acta Radiol Diagn (Stockh) 1985; 26:425-426.
- 18 Schwartz HS, Walker R. Recognizable magnetic resonance imaging characteristics of intramuscular myxoma. Orthopedics 1997; 20:431-435.
- 19 Shugar JM, Som PM, Meyers RJ, Schaeffer BT. Intramuscular head and neck myxoma: report of a case and review of the literature. Laryngoscope 1987; 97:105-107.
- 20 Carney JA. Carney complex: the complex of myxomas, spotty pigmentation, endocrine overactivity, and schwannomas. Semin Dermatol 1995; 14:90-98.
- 21 Aoki T, Kouho H, Hisaoka M, Hashimoto H, Nakata H, Sakai A. Intramuscular myxoma with fibrous dysplasia: a report of two cases with a review of the literature. Pathol Int 1995; 45:165-171.
- 22 Cabral CE, Guedes P, Fonseca T, Rezende JF, Cruz LC, Jr, Smith J. Polyostotic fibrous dysplasia associated with intramuscular myxomas: Mazabraud’s syndrome. Skeletal Radiol 1998; 27:278-282.
- 23 Court-Payen M, Ingemann Jensen L, Bjerregaard B, Schwarz Lausten G, Skjoldbye B. Intramuscular myxoma and fibrous dysplasia of bone: Mazabraud’s syndrome— a case report. Acta Radiol 1997; 38:368-371.
- 24 Fujii K, Inoue M, Araki Y, Ishida O. Multiple intramuscular myxomas associated with polyostotic fibrous dysplasia. Eur J Radiol 1996; 22:152-154.
- 25 Gober GA, Nicholas RW. Case report 800: skeletal fibrous dysplasia associated with intramuscular myxoma (Mazabraud’s syndrome). Skeletal Radiol 1993; 22:452-455.
- 26 Kransdorf MJ, Murphey MD. Case 12: Mazabraud syndrome. Radiology 1999; 212:129-132.
- 27 Lever EG, Pettingale KW. Albright’s syndrome associated with a soft-tissue myxoma and hypophosphataemic osteomalacia: report of a case and review of the literature. J Bone Joint Surg Br 1983; 65:621-626.
- 28 Logel RJ. Recurrent intramuscular myxoma associated with Albright’s syndrome. J Bone Joint Surg Am 1976; 58:565-568.
- 29 Mazabraud A, Semat P, Roze R. Apropos of the association of fibromyxomas of the soft tissues with fibrous dysplasia of the bones. Presse Med 1967; 75:2223-2228. [French].
- 30 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.
- 31 Wirth WA, Leavitt D, Enzinger FM. Multiple intramuscular myxomas: another extraskeletal manifestation of fibrous dysplasia. Cancer 1971; 27:1167-1173.
- 32 Witkin GB, Guilford WB, Siegal GP. Osteogenic sarcoma and soft tissue myxoma in a patient with fibrous dysplasia and hemoglobins JBaltimore and S. Clin Orthop 1986; 51:245-252.
- 33 Bianchi S, Zwass A, Abdelwahab IF, Mazzola CG, Olivieri M, Rettagliata F. Sonographic evaluation of intramuscular ganglia. Clin Radiol 1995; 50:235-236.
- 34 Bianchi S, Abdelwahab IF, Zwass A, Giacomello P. Ultrasonographic evaluation of wrist ganglia. Skeletal Radiol 1994; 23:201-203.
- 35 De Flavis L, Nessi R, Del Bo P, Calori G, Balconi G. High-resolution ultrasonography of wrist ganglia. J Clin Ultrasound 1987; 15:17-22.
- 36 Paivansalo M, Jalovaara P. Ultrasound findings of ganglions of the wrist. Eur J Radiol 1991; 13:178-180.
- 37 DeFriend DE, Schranz PJ, Silver DAT. Ultrasound-guided aspiration of posterior cruciate ligament ganglion cysts. Skeletal Radiol 2001; 30:411-414.
- 38 Ward EE, Jacobson JA, Fessell DP, Hayes CW, van Holsbeeck M. Sonographic detection of Baker’s cysts: comparison with MR imaging. AJR Am J Roentgenol 2001; 176:373-380.
- 39 Helbich TH, Breitenseher M, Trattnig S, Nehrer S, Erlacher L, Kainberger F. Sonomorphologic variants of popliteal cysts. J Clin Ultrasound 1998; 26:171-176.
- 40 Jelinek JS, Kransdorf MJ, Shmookler BM, Aboulafia AJ, Malawer MM. Liposarcoma of the extremities: MR and CT findings in the histologic subtypes. Radiology 1993; 186:455-459.
- 41 Murphey MD, Gross TM, Rosenthal HG. From the archives of the AFIP: musculoskeletal malignant fibrous histiocytoma—radiologic-pathologic correlation. RadioGraphics 1994; 14:807-826.
- 42 Murphey MD, Fairbairn KJ, Parman LM, Baxter KG, Parsa MB, Smith WS. From the archives of the AFIP: musculoskeletal angiomatous lesions—radiologic-pathologic correlation. RadioGraphics 1995; 15:893-917.
- 43 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.
- 44 Sung MS, Kang HS, Suh JS, et al. Myxoid liposarcoma: appearance at MR imaging with histologic correlation. RadioGraphics 2000; 20:1007-1019.
- 45 Sundaram M, Baran G, Merenda G, McDonald DJ. Myxoid liposarcoma: magnetic resonance imaging appearances with clinical and histological correlation. Skeletal Radiol 1990; 19:359-362.
- 46 Murphey MD, Flemming DJ, Jelinek JS, Temple HT, Levine AM, Torop AH. Imaging of higher grade liposarcoma with pathologic correlation (abstr). Radiology 1997; 205(P):332.
- 47 Bancroft LW, Kransdorf MJ, Menke DM, O’Connor MI, Foster WC. Intramuscular myxoma: characteristic MR imaging features. Am J Roentgenol 2002; 178:1255-1259.
- 48 Iwasko N, Steinbach LS, Disler D, et al. Imaging findings in Mazabraud’s syndrome: seven new cases. Skeletal Radiol 2002; 31:81-87.