Surgical Treatment of Intramuscular Myxoma
Sermsak Sukpanichyingyong1, Seiichi Matsumoto1, Keisuke Ae1
1Department of Orthopaedic Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550 Japan.
Insights
Marginal resection is effective for intramuscular myxoma (IM), preventing recurrence and preserving muscle. If a sarcoma is found post-surgery, minimal contamination allows for less invasive further treatment.
Area of Science:
- Orthopedic Surgery
- Surgical Oncology
- Musculoskeletal Pathology
Background:
- Intramuscular myxoma (IM) is a rare benign tumor often mistaken for sarcoma in biopsies.
- IM microscopically infiltrates surrounding muscle despite a macroscopically well-circumscribed appearance.
- Optimal surgical margins for IM resection remain debated.
Purpose of the Study:
- To determine the appropriate surgical procedure for preoperative IM diagnosis.
- To establish management strategies for postoperative diagnoses of sarcoma.
- To evaluate the efficacy of different surgical margins for IM.
Main Methods:
- Retrospective review of 55 IM patients treated between 1982 and 2014.
- Analysis of patient demographics, tumor characteristics, surgical techniques, and outcomes.
- Minimum 5-year follow-up for all patients, excluding Mazabraud syndrome cases.
Main Results:
- The study included 55 patients (mean age 48 years, predominantly female).
- Common locations were thigh (47%) and buttock (20%) muscles; mean tumor size was 5 cm.
- No local recurrence, malignant transformation, or complications were observed after marginal or wide resection over a mean 19-year follow-up.
Conclusions:
- Marginal resection is a suitable approach for IM, effectively preventing recurrence and preserving muscle and fascia.
- This approach minimizes surgical contamination, facilitating less invasive treatment if a postoperative sarcoma diagnosis is made.
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.
