Juxta-articular Myxoma Research Articles

A Juxta-Articular Myxoma of the Thumb in a young male: A case report

Juxta-articular myxomas are benign tumours that are most commonly associated with larger joints. Cases involving hand have been rarely reported till date. We present a case of a juxta-articular myxoma at the metacarpophalangeal joint of the thumb in a 30-year-old male patient. The preoperative diagnostic work-up included ultrasound and X-ray of left hand. The histopathological examination of the resected tumor confirmed the diagnosis. Follow-up ultrasound six months after surgery revealed no obvious recurrence. At 6 months, the patient had full range of motion without pain.

The Role of Early Temporomandibular Joint Arthroscopy in the Detection, Diagnosis, and Surveillance of Synovial Neoplasms: A Massachusetts General Hospital Experience and Algorithm of Care

PurposeSynovial neoplasms that affect the small joints, such as the temporomandibular joint (TMJ), are uncommon.1 Of the neoplasms that affect the TMJ, pigmented villonodular synovitis (PVNS), synovial chondromatosis (SC), and juxta-articular myxoma are the most prevalent. To date, there have been only 115 and 360 reported cases of PVNS and SC of the TMJ in the literature, respectively.2 These lesions are locally destructive with the capacity to invade the cranial base and often demonstrate an inconspicuous growth pattern, a high degree of recurrence, and presentation that is confounded with other forms of temporomandibular joint disorder. TMJ arthroscopy has been established as a minimally invasive surgical modality to establish diagnosis and reduce patient morbidity. The purpose of the present study was to evaluate the role and impact of TMJ arthroscopy in the early detection, diagnosis, treatment, and surveillance of PVNS and SC of the TMJ. Patients and methodsThis is a retrospective case series. Inclusion criteria were patients with synovial neoplasms: specifically, PVNS and SC at Massachusetts General Hospital. Exclusion criteria were patients with malignant tumors involving the TMJ and cranial base and tumors arising from extra-articular, non-synovial origin. Patients were categorized into 2 groups: Group I (who did not undergo early TMJ arthroscopy prior to lesion excision) and Group II (who did undergo early TMJ Level II [multi-port] arthroscopy prior to lesion excision). Pre-operative time to definitive lesion excision surgery, pre-operative biopsy status, extent of surgery (arthroscopic removal vs. open arthrotomy with or without craniotomy), and lesion recurrence were evaluated. ResultsA total of 6 patients were included in the present study (3 men and 3 women), all unilateral involvement for a total of 6 sides. The mean age was 31 (15-61). Patients were categorized into 2 groups: Group I-3 PVNS patients identified. All patients did not have a pre-operative biopsy prior to lesion excision. Mean pre-operative time duration to definitive lesion removal from initial presentation was 12 months. One isolated open arthrotomy and 2 open arthrotomy with craniotomy were required due to tumor growth and invasion of the middle cranial fossa. Recurrence of the lesion was present in 2 cases requiring repeat excision. Group II consisted of 3 patients: 2 PVNS (Figure 1) and 1 SC (Figure 2). All patients had pre-ablative biopsy diagnosis yielded from arthroscopic synovial biopsy. Mean pre-operative time duration to definitive lesion removal from initial presentation was 7 months. One PVNS case was excised arthroscopically. One isolated open arthrotomy and 1 open arthrotomy with craniotomy were required for definitive lesion excision. No lesion recurrence was noted, with 1 second-look arthroscopy conducted. ConclusionThe results from the present study demonstrated that the early TMJ arthroscopy has efficacy in the early detection, diagnosis, and surveillance of synovial neoplasms PVNS and SC. Visualization and synovial biopsy of the lesion provide diagnostic and surgical planning benefit in conjunction with standard pre-operative workup. One lesion was arthroscopically removed. No recurrence has occurred, and TMJ arthroscopy proffers a minimally invasive means for disease surveillance if recurrence is suspected. Larger studies with continued follow-up are needed to further establish the algorithm established by this work to continue to minimize patient morbidity with lesion excision and reduce recurrence rates.

Spinal Myxoma of the Facet Joint: A Case Report

Myxoma is a benign soft tissue tumor that can occur in a variety of locations. Intramuscular localization is common, myxomas of the paravertebral muscle are relatively rare and only few cases have been described in literature. Juxta-articular myxoma on facet joint is extraordinary. The current case described paraspinal muscles juxta-articular myxoma of the lumbar region in a 61-year-old man causing back pain and sciatica. Radiological findings showed a mass in the nearby of L5-S1 facet joints mimicking a big synovial cyst that deepened down into the psoas major muscle. A PET scan showed a higher metabolism involving the mass and no other localizations. Intraoperative histological analysis was consistent with Juxta-articular myxoma (JM). Treatment of choice was surgical excision, with complete relief of symptoms afterwards.

The Viscous Juncture-Juxta Articular Myxoma

Juxta-articular myxoma is an uncommon, benign, hypocellular, bland, myxoid neoplasm of mesenchymal origin occurring within the vicinity of a large joint such as the knee. The neoplasm is exemplified within 16 years to 83 years with a median age at 43 years. A male predominance is observed with a male to a female proportion of nearly 3:1. Localized tissue destruction arising on account of the neoplasm can engender pain or nerve palsy. The minimally cellular tumefaction depicts an abundant, myxoid stroma admixed with a non-malignant proliferation of spindle-shaped cells. Juxta-articular myxoma is immune reactive to vimentin and CD34.

Juxta-articular myxoma of the temporomandibular joint: Case report and review

Juxta-articular myxoma of the temporomandibular joint: Case report and review

Juxta-articular myxoma arising from a lumbar facet joint

Juxta-articular myxoma arising from a lumbar facet joint

Fibular juxta-articular ganglion: A rare case report and literature review.

This is the case report of a 65-year-old man who experienced left calf pain after spraining his left ankle. On magnetic resonance imaging (MRI), a well-defined fluid collection was identified, with low intensity on T1-weighted images and very high intensity on T2-weighted images. On certain slices, a soft tissue mass in the proximal fibula was identified. Following resection of the fibular lesion, histological examination confirmed a benign tumor with cystic elements, described in the current pathology and radiology literature as juxta-articular myxoma. This is a rarely encountered but well-recognised cystic lesion, commonly developing around the knee, that is often misdiagnosed as ganglion cyst, synovial lipoma, lipoma arborescens and pigmented or non-pigmented villonodular synovitis. Given its more cellular nature and thicker encapsulation, juxta-articular myxoma may be differentiated from ganglion cyst on MRI with a high index of suspicion, and it is crucial that it is recognized due to its high rate of recurrence. In the present case, the localization of this lesion within the fibula was uncommon, and there was also a soft tissue mass identified outside the bone. Wide resection of the lesion was performed. Recovery was uneventful and the patient remains symptom- and recurrence-free at 8-months follow-up.

Abundant lubricin expression suggests a link between synoviocytes, synovial tumors, and myxomas.

Progenitor cell differentiation into fibroblast-like synoviocytes (FLSs) and their ensuing phenotypic changes are incompletely explored. Synovial lining is composed of intimal macrophages and FLSs. FLSs have epithelioid morphology and directionally secrete components of synovial fluid, including lubricin. We stained human tissues and tumors using two anti-lubricin antibodies. Lubricin was found in FLSs in synovium and in tenosynovial giant cell tumors (TSGCTs) and not in the associated monocyte/macrophage cells, which were identified by double immunostaining for CD163. In TSGCTs, giant cells, known to form by fusion of mononuclear cells, were negative for both lubricin and CD163. Occasional mononuclear cells with the same phenotype were also seen, suggesting that the precursors of the giant cells are derived from the minor CD163-negative monocyte subset. Lubricin was also detected in intramuscular myxomas, in early myxoid changes of ganglion cysts, and in one of five low-grade myxofibrosarcomas, but not in other fibroconnective tissues, epithelial tissues, or other tumors tested. This suggests that lubricin expression may typify adaptive and neoplastic changes along a pathway toward FLSs. Further support for this concept comes from ganglion cysts and juxta-articular myxoma tumors, which show a spectrum of myxoid, cystic and synovial differentiation, and in which moderate lubricin staining of myxoid stroma was seen.

Juxta-Articular Myxoma of the Knee Joint

Juxta-Articular Myxoma of the Knee Joint

Diagnostic value of CT and MRI in myxoid soft tissue tumours

Objective To study the CT and MRI characteristics of myxoid soft tissue tumours. Methods Fifty-three myxoid soft tissue tumours pathologically confirmed were retrospectively studied. MR and CT scan were performed before operation. Noncontrast T1 and T2 weighted images, fat-suppressed T2 weighted images were obtained before contrast-enhanced scan with fat-suppressed T1 weighted sequence was underwent. Plain and contrast-enhanced CT was performed with tube potential of 120 kV, matrix 512×512, and automatic tube current modulation technique. Results There were 18 myxoid liposarcoma, 3 ganglioneuroma, 8 myxofibrosarcoma, 2 extraskeletal myxoid chondrosarcoma, 10 intramuscular myxoma, and 2 juxta-articular myxoma. Microscopic examination showed myxoid soft tissue tumours which were consisted of abundant myxoid stroma with tumour cells and blood vessels associated with fibrous bands. Low density in CT images, hypointensity in T1 weighted images, significantly hyperintense in T2 weighted images were their common manifestations in the area of abundance of extracellular myxiod matrix. Plain CT images demonstrated equidensite, T1 weighted images isointensity, and fat-suppressed T1 weighted images significant enhancement relatively in the areas of increased number of tumor cells. Hemorrhage, necrosis and capsule of the lesion were revealed in high grade malignant tumors. The septa can be identified in most of myxoid tumours of soft tissue. Conclusion CT and MRI can definitely show the image characteristics of myxiod soft tissue tumours, which can help make a qualitative diagnosis before operation. Key words: Soft tissue neoplasms; Tomography, X-ray computed; Magnetic resonance imaging

Intense Lubricin Expression Defines Synoviocyte Differentiation and Detects Cells in Synovium‐Related and Myxoid Tumors

Immunoprofiles of synovium-related tumors, such as Giant Cell Tumor of Tendon Sheath (GCTTS), are incompletely explored, partly due to lack of lineage defining synoviocyte markers. Synovial lining is comprised of intimal macrophages and fibroblast-like synoviocytes (FLS). FLS produce lubricin, a mucin-like glycoprotein in synovial fluid. Lubricin expression in synovium, GCTTS and myxomas was assessed by immunohistochemistry using two anti-lubricin antibodies: S6.79, monoclonal antibody, raised against purified, native lubricin, and Ab28484, an affinity purified polyclonal antibody made against a C-terminal peptide. In synovium, lubricin reactivity was limited to intimal synoviocytes with cytoplasmic and surface lining staining Double staining using Ab28484 and anti-CD163, a marker of synovial intimal macrophages, showed non-overlap between the two synoviocyte types. In GCTTS, lubricin cytoplasmic expression was limited to large, plump cells, but not giant cells or smaller mononuclear cells Double staining showed lubricin positive cells were CD163 negative. Scattered mononuclear cells negative for both lubricin and CD163were present. A case of juxta-articular myxoma with extensive ganglion cyst-like areas showed moderate staining of myxoid stroma and intense staining of cyst lining using S6.79. A tumor of uncertain lineage showed reactivity, suggesting relatedness to FLS. Thus, lubricin expression defines cells within synovium-related and myxoid tumors.

Juxta-articular myxoma of the shoulder in an 85-year-old female: a case report and literature review

Juxta-articular myxoma is rare soft tissue tumour of uncertain differentiation, which commonly arises in close proximity to large joints, in particular the knee. 1 This case review involves an 85-year-old woman who presented with an intermittently painful, slowly growing mass overlying the right deltoid. The mass enlarged over a period of years following a fall onto her right arm and was more rapidly growing in recent months. CT imaging demonstrated a well-circumscribed mass overlying the right deltoid with the superior aspect in close proximity to the right shoulder bursa. Macroscopically the tumour (85 × 40 × 40 mm) cut surface was slimy and gelatinous with occasional clear viscous fluid filled cysts ranging from 2–20 mm. Microscopically the lesion was hypocellular and composed of bland spindle cells in a myxoid stroma with occasional cystic, ganglion-like spaces with various wall linings ranging from fibrin through to a thick layer of collagen. The tumour cells were shown to be CD34, SMA and vimentin positive as well as S100 negative. Whilst the identification of a myxoma is not challenging, identification of a juxta-articular myxoma requires careful consideration of the clinical, radiological and pathological details, which will be presented in full along with a review of the literature.

Juxta-articular myxoma of the wrist

This case report describes a juxta-articular myxoma(JAM) in an uncommon location, demonstrating an unusually aggressive local growth pattern.

Juxta-articular myxoma of the palm.

We present a case of juxta-articular myxoma of the hand in a 63-year-old man with an enlarging mass over the palmar radial aspect of the index metacarpophalangeal joint. Usually seen in men, this benign soft tissue tumour is normally found around large joints. To our knowledge this is the first reported case in the hand.

Juxta-articular Myxoma of the Knee

Juxta-articular myxoma is a benign lesion usually presenting as a slow-growing, well-circumscribed mass. Occasionally, however, the lesion grows rapidly and is poorly circumscribed, and it is this clinical presentation that arouses suspicion of malignancy. Furthermore, on histology a myxoma can also be confused with a variety of sarcomas. We present a case of juxta-articular myxoma and discuss the possible diagnostic dilemmas involved.

Myxome juxta articulaire du poignet : à propos d’un cas

Juxta articular myxomas are rare tumors. The treatment is surgical with a high recurrence rate. A location proximal to the wrist joint is exceptional. We report a case of juxta articular myxoma of the wrist in a 30-year-old patient, with no recurrence four months after surgical excision.

Juxta-articular myxoma of the knee in a 5-year-old boy: a case report and review of the literature (2009: 12b)

Juxta-articular myxoma (JAM) is a relatively rare variant of myxoma that occurs in the vicinity of large joints. It is composed of fibroblast-like cells that produce an excessive amount of glycosaminoglycans rich in hyaluronic acid. The peak incidence is between the 3rd and 5th decades of life. In this report we describe an extremely rare case of JAM in the knee of a 5-year-old child. The clinical presentation, radiological features and histopathologic findings are described, and the relevant literature is reviewed.

Juxta-articular Myxoma Within the Suprapatellar Pouch Masquerading as a Ganglion Cyst

This article presents the case of a 63-year-old man who noted painless swelling within the suprapatellar pouch, which he attributed to an effusion. Small-magnet, lower-extremity magnetic resonance imaging (MRI) and subsequent arthroscopy missed the lesion. On MRI with gadolinium contrast, the lesion was defined but misdiagnosed as a suprapatellar pouch ganglion cyst. Following resection of the 6 x 5 x 1.8-cm lesion, histology confirmed a lobular benign tumor with cystic elements recognized in the pathology and radiology literature as juxta-articular myxoma. Such lesions are characteristically multilobulated and contained within a capsular rim that enhances with gadolinium venous contrast. Otherwise, they appear hyperintense to fat on T2-weighted images and hypointense to muscle on T1-weighted images. This is an uncommonly encountered but known cystic lesion around the knee that is most often confused with ganglion cyst, synovial lipoma, lipoma arborescens, or pigmented or non-pigmented villonodular synovitis. Given its more cellular nature and thicker encapsulation, it should be able to be differentiated from ganglion cyst on MRI with a high index of suspicion, and should be recognized because of its high rate of recurrence. Unusual in this case was its location within the suprapatellar pouch, demonstrating the ease with which such lesions can be missed arthroscopically despite significant mass.

Persistierende Knieschmerzen und palpabler Tumor in der Kniekehle

The case of a female Patient with increasing pain and a palpable mass in the right popliteal fossa shows the spectrum of possible differential diagnoses for the radiologist. The diagnosis of a juxtaarticular myxoma made on the interpretation of conventional x-ray and magnetic resonance imaging was finally confirmed by biopsy.

Myxoma of the Oral Soft Tissues: Report of a Case and Literature Review

Soft tissue myxomas are benign tumors of uncertain differentiation, arising in somatic soft tissues mostly within skeletal muscles, dermal and subcutaneous tissues, pelviperineal tissues, and adjacent to a large joint. They are classified as intramuscular myxoma, digital myxoma, superficial angiomyxoma, aggressive angiomyxoma, and juxta-articular myxoma. Although they are not encapsulated and may progressively invade the surrounding tissues, they have a benign behavior. Soft tissue myxomas affect persons of all ages although rarely children and young adolescents. Twenty percent of tumors grow intramuscularly (intramuscular myxoma); they are found frequently in the muscles of the thigh. In the maxillofacial regions soft tissue myxomas have been found in the skin and subcutaneous tissue, the fascia, the parotid gland, the larynx, the tonsils, and the ear. Soft tissue myxomas are found infrequently in the oral cavity. Only 24 cases were discovered in our review of the literature. We therefore thought it worthwhile to present a new case of soft tissue myxoma affecting the buccal mucosa.