Juxta-articular Myxoma Research Articles

Juxta-articular myxoma of the wrist: A case report

A 16-year-old boy with a 4-month history of pain and a palpable mass in the right wrist was presented to our clinic. Preoperative diagnosis was a ganglion cyst according to symptoms and physical examination. The lesion was removed by marginal resection and histopathologic examination revealed a juxta-articular myxoma. No recurrence was detected at 1-year follow-up evaluation. We report a case of juxta-articular myxoma of the wrist joint.

Juxta-articular myxoma: a rare cause of painful restricted motion of the knee

A 68-year-old athletic woman presented to our institution in January 2002 with a several-month history of progressing complaints of pain, swelling, and loss of motion in the right knee. These manifestations had begun the previous July during a game of tennis. She experienced persisting pain and recurring effusions. Because the patient had been residing in another state between July and January, rheumatologic and orthopaedic evaluations of the knee, including a magnetic resonance imaging (MRI), had been performed at a geographically distant (but affiliated) institution. The resulting presumptive diagnosis was a “wear and tear” degenerative articular disorder of the knee. A program of anti-inflammatory medication and physical therapy was begun for several months but produced no therapeutic benefit by the time the patient presented at our institution. After examination confirmed marked losses of both flexion and extension of the knee, effusion, and exquisite medial joint tenderness, an MRI was repeated, using intra-articular gadolinium as a contrast agent. It revealed an intra-articular mass encircling the medial and posterior extents of the medial femoral condyle. An arthroscopic multiportal excisional biopsy was performed. It revealed the existence of a juxta-articular myxoma. The patient recovered most of the range of motion during the next several months, and the effusion and severe pain gradually dissipated. The patient was subsequently followed by sequential physical examinations and MRIs, performed at increasing intervals of time, without recurrence of a mass or of her flagrant symptoms in the first year post surgery. Though the patient’s diagnosis was established and treatment outcome was satisfactory, many issues were brought up in this case regarding most appropriate selection of diagnostic tests and treatment approaches.

手関節近傍に発生した粘液腫（juxta-articular myxoma）の1例

手関節近傍に発生した粘液腫（juxta-articular myxoma）の1例

Juxta-articular myxoma and intramuscular myxoma are two distinct entities. Activating Gs alpha mutation at Arg 201 codon does not occur in juxta-articular myxoma.

Juxta-articular myxoma is a rare myxoid tumor of soft tissue that bears a close histologic resemblance to intramuscular myxoma but is distinguished from the latter by its clinical setting and behavior. Activating missense mutations at the Arg 201 codon of the Gs alpha gene ultimately leading to increased levels of cyclic adenosine monophosphate have been implicated in McCune-Albright syndrome and sporadic fibrous dysplasia of bone. Recently, we have demonstrated that the same Gs alpha mutations occur in intramuscular myxomas associated with fibrous dysplasia of bone (Mazabraud's syndrome) as well as in sporadic intramuscular myxoma. The overlapping histologic appearances of juxta-articular myxoma and intramuscular myxoma prompted us to investigate whether there is a relationship between the two entities. We studied this possibility by looking for Gs alpha mutations in juxta-articular myxoma using polymerase chain reaction (PCR) to amplify appropriate genomic DNA fragments extracted from formalin-fixed, paraffin-embedded specimens of five juxta-articular myxomas, followed by single-strand conformation polymorphism analysis. Using these techniques, no aberrant bands were detected in any of the five juxta-articular myxomas, indicating that they lack Gs alpha mutations. Moreover, DNA sequencing of the PCR products of two JAMs showed no abnormalities. We conclude that juxta-articular myxomas, in contrast to intramuscular myxomas, do not involve Arg 201 mutations of the Gs alpha gene, indicating that they represent distinct entities with different underlying molecular mechanisms.

Myxoma is not a single entity: a review of the concept of myxoma.

Myxoid lesions can be subdivided into (1) mainstream myxomas of soft tissues, (2) mainstream myxomas located outside the soft tissue, (3) inadequately substantiated myxomas, (4) myxoid soft tissue tumors or lesions not regarded as myxomas, (5) myxoid fatty conditions, (6) other soft tissue lesions and tumors that are sometimes markedly myxoid, (7) other soft tissue tumors in which myxoid foci may be seen, and (8) nonneoplastic myxoid conditions of soft tissue. More than 60 such conditions are listed and the five entities regarded as mainstream soft tissue myxomas (namely, intramuscular myxoma, juxta-articular myxoma, superficial angiomyxoma, aggressive angiomyxoma, and myxoid neurothekeoma [myxoma of nerve sheath]) are reviewed in detail. Intramuscular myxoma is exclusively intramuscular, usually affects middle-aged women, is most commonly located in the thigh, and does not recur after simple excision. Multiple intramuscular myxomas are rare and are usually associated with monostotic or polyostotic fibrous dysplasia and Albright's syndrome. Juxta-articular myxoma histologically resembles an intramuscular myxoma, but involves periarticular tendons, ligaments, joint capsules, muscles, and even the subcutis of adults. It may be associated with osteoarthritis of the adjacent joint. Some 30% recur locally. Superficial angiomyxoma also has been called cutaneous myxoma. It affects all ages, with a peak incidence in the third and fourth decades; arises in the trunk, lower limb, head, and neck regions; and usually measures less than 5 cm in diameter. Epithelial components are present in approximately 25% of tumors. Approximately one third recur locally, but there have been no metastases. Patients with multiple lesions may have the Carney complex. Aggressive angiomyxoma usually arises in the pelvic and perineal regions and affects females seven times as often as males. Tumors usually measure 10 cm or more in diameter, invade surrounding tissues, and recur in approximately 50% of cases. None have metastasized. Myxoma of nerve sheath (the myxoid variant of neurothekeoma) preferentially affects the dermis and subcutis of the cervicofacial areas and shoulders of young women. Most patients are younger than 40 years; one third of them are in the second decade of life. The majority of tumors measure between 0.5 and 1.5 cm. Only three of 102 cases compiled from the two largest published series recurred; none metastasized. The different clinicopathologic features and behavior of these five mainstream myxomas indicate that myxoma is not a single entity.

Juxta-articular myxoma of the shoulder presenting as a cyst of the acromioclavicular joint: A case report

Treatment of patients with subcutaneous cystic lesions of the acromioclavicular joint has yielded unpredictable results unless the underlying pathologic process producing the cyst is addressed.4,9 Three causes of this lesion have been reported in the literature: true ganglion,9,2 mechanical irritation of a degenerated acromioclavicular joint by direct contact with the humeral head through a rotator cuff defect,8 and up-welling of glenohumeral joint fluid through a rotator cuff defect (“geyser” sign).3,4 We report a case of juxta-articular myxoma of the shoulder involving both the acromioclavicular joint and the glenohumeral joint in the presence of a large rotator cuff tear as an additional cause of acromioclavicular cyst. The aggressive behavior of this lesion compared with other known causes warrants the attention of surgeons who evaluate and treat this condition. CASE REPORT A 68-year-old right-hand-dominant man had a soft tissue mass over the superior surface of his right acromioclavicular joint compatible with subcutaneous acromioclavicular cyst. The lesion was excised by a general surgeon in the patient’s home district but recurred 5 weeks later. The cyst was reexcised, and a pathologic diagnosis of juxta-articular myxoma was confirmed by the Armed Forces Institute of Pathology. Two months later recurrence in the same location prompted referral to our facility for evaluation and further treatment. Physical examination showed a 2.5-cm marble-sized soft tissue mass superior to the right acromioclavicular joint with marked erythema, shiny skin edges at the previous scar, and dense induration and firm attachment to the underlying acromion. Glenohumeral range of motion was unrestricted; no pain was elicited on motion examination. After routine radiography was performed, computed tomography scan indicated erosion of the acromioclavicular joint and apparent cystic change in the humeral head. Magnetic resonance imaging evaluation of the shoulder with the 1.5-Tesla Siemens Magnetom System suggested a chronic rotator cuff tear, subdeltoid fluid, a synovial or gan

Juxta-articular myxoma of the shoulder presenting as a cyst of the acromioclavicular joint: A case report

Juxta-articular myxoma of the shoulder presenting as a cyst of the acromioclavicular joint: A case report

A case of juxta-articular myxoma of the knee

This 9-year-old girl presented with a painful mass in the posterolateral aspect of her right knee. Excisional biopsy of the mass revealed a juxta-articular myxoma. The differential diagnosis for such an intra- or periarticular mass should include meniscal cyst, parameniscal cyst, ganglion cyst, juxta-articular myxoma, focal nodular PVNS, and desmoid tumor. Current imaging techniques do not allow differentiation between these benign lesions and low grade myxoid-containing sarcoma.

Perce the permissive pathologist: a cautionary tale of one who misdiagnosed a pseudosarcoma, killed the patient and was found out.

Perce, a promising young trainee pathologist, correctly recognizes a biopsy of a benign pseudosarcoma but his diagnosis is overruled by the less well read Head of Pathology. Acting under instructions from his Chief, Perce knowingly and without protest 'signs out' this benign condition as a sarcoma. The surgeon accepts the diagnosis without question and performs radical surgery, which is complicated by postoperative haemorrhage from which the patient dies. The Coroner orders a review of the slides and the misdiagnosis is discovered. Perce's defense that he did as he was told is rejected; he is forced to quit pathology and becomes an administrator. This unfortunate tale, which is related in verse, is intended to stress the importance of such benign but uncommon pseudosarcomas as nodular fasciitis, proliferative myositis, myositis ossificans, postoperative spindle cell nodule, pseudosarcoma of the bladder and juxta-articular myxoma. The poem also implies that surgeons should not carry out radical surgery based on an uncommon pathological diagnosis without checking on the adequacy of consultation and informed review of the sections.

Juxta-articular myxoma: A clinical and pathologic study of 65 cases

We describe 65 cases of juxta-articular myxoma (JAM) that occurred in the vicinity of large joints, possessed histologic features of a myxoma, and were frequently associated with cystic changes that resembled a ganglion cyst. The vast majority of cases (57, 88%) occurred in the region of the knee; a minority involved the shoulder (three cases), elbow (three), ankle (one), and hip (one) regions. Patients' ages ranged from 16 to 83 years (median, 43 years; mean, 44 years) and nearly three fourths of the patients (72%) were male. Thirty-seven lesions presented as a swelling or mass, 21 were associated with pain or tenderness, and sizes ranged from 0.6 to 12 cm (median, 3.5 cm; mean, 3.8 cm). Duration of symptoms was highly variable, spanning from 1 week to 18 years. Fourteen JAMs were intimately associated with the meniscus and five of these had a concomitant tear; in five other cases JAM was an incidental finding at the time of total knee or hip arthroplasty for severe osteoarthritis. Of 29 cases with follow-up, 10 (34%) recurred: five recurred once, two recurred twice, two recurred three times, and one recurred four times. While the majority of JAMs were correctly diagnosed as benign, a sarcoma was seriously considered or diagnosed in 15 (23%) cases.