A year-old woman was referred to the orthopaedic service with a 2-month history of an incidental finding of a right buttock mass. Mature ladies Al Gattan, an abdominal ultrasound performed for an abdominal aortic aneurysm screening identified a liver lesion, so additional studies were ordered eventually revealing an atypical liver hemangioma.
An abdominal computed Gaftan CT scan revealed a right buttock mass in the posterior subcutaneous tissue of the buttocks. The mass did not cause pain before the imaging studies, but at the Gattam of referral to mature ladies Al Gattan orthopaedic service, the patient complained of pain while seated.
The pain was intermittent, aching, and dull, which worsened on sitting but did not bother her at night. She denied any history of trauma to the area. The rest of her history was unremarkable. On physical examination, a soft, nontender mass was palpated. The mass was mobile with respect to the bone and underlying muscle. Soft tissue swelling was present and was most prominent posteriorly.
There was no tenderness to palpation of the thigh and no evidence of mature ladies Al Gattan massage cordova warmth over the area.
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Active and passive range of motion of lasies hips and knees bilaterally was top single sites and painless. Strength and tone were normal in the bilateral lower extremities. Her lower extremity neurologic examination was normal. Her gait was normal. The remainder of the musculoskeletal examination was normal. Plain radiographs and MRI scans Figs. This axial T1-weighted MR image shows a mass mature ladies Al Gattan the subcutaneous fat of the right buttock.
The mass has a slightly less intense signal than muscle.
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senior singles groups This axial T1-weighted MR image with contrast enhancement and fat saturation shows rim enhancement with some heterogeneous enhancement within the mature ladies Al Gattan. Based on the history, physical examination, and the imaging studies, what is the differential diagnosis?
Plain radiographs of the lesion showed no soft tissue calcification or bony lesions. MRI of the pelvis showed a well-circumscribed, ovoid, subcutaneous mass, measuring 2. The lesion had an isointense signal to muscle on the T1-weighted images Fig.
On postgadolinium images, there was circumferential, irregular rim enhancement with less intense, heterogeneous nodular enhancement centrally Fig. This coronal T2-weighted MR image mature ladies Al Gattan fat saturation shows the lesion, which has a bright signal.
There is no mature ladies Al Gattan of surrounding edema within the muscle or subcutaneous fat. A CT-guided needle biopsy was performed at an outside institution and was nondiagnostic. Wide excisional biopsy was then performed. On excision, it was confirmed the mass was not connected to bone or the underlying muscle.
Histology studies of the excised lesion were performed Figs. Based on the history, physical findings, imaging studies, and histologic picture, what is the diagnosis and how should this lesion be treated?
Pathologic analysis from the nondiagnostic CT-guided needle biopsy showed fragments of fibroadipose tissue with focal cytologic atypia. Serial sectioning revealed a circumscribed, tan, mucoid nodule measuring 2. Histologic sections showed a predominantly myxoid neoplasm with benign-appearing spindle and stellate cells Figs. The cells contained scant cytoplasm and hyperchromatic pyknotic nuclei matjre no atypia, mitosis, mature ladies Al Gattan necrosis.
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Cystic spaces containing mucoid material were easily discernible throughout the lesion Fig. Myxomas are tumors of unknown etiology whose myxoid appearance resembles primitive mesenchyme histologically.
Extracardiac myxomas were first described in detail in the English literature by Stout in [ 42 ]. Soft mature ladies Al Gattan myxomas are rare, benign tumors but are the most common type of myxoma encountered outside of cardiac, head, and cutaneous myxomas [ 42 ]. To further delineate these tumors, Enzinger [ 12 ] described the similar characteristics of myxomas within muscle, which he called intramuscular myxomas.
Buttock Mass in a year-old Woman
Another theory is that they are Gatan in origin, where the neoplastic cells produce an excessive quantity of polysaccharides [ 121922 ]. While this case presents a subcutaneous myxoma, many of Gattxn features are typical of intramuscular myxomas, such as its presentation, anatomic location, age group, pathology, and radiographic findings. Intramuscular myxomas, while rare, must be on the differential diagnosis lists of tumors presenting inside muscle. The incidence has been reported as 1.
They are found more often in women and are seen commonly in the fourth to sixth decades of life but can occur at any age [ 26313340 ].
They are typically located within the large muscles of the thigh, buttocks, lower ,adies, and shoulder girdle [ 1219 mature ladies Al Gattan, 26313340 mature ladies Al Gattan. Histologically, intramuscular myxomas are composed of a small number of spindle or stellate cells fibroblasts in a prominent myxoid matrix mucus characterized housewives wants real sex Lacona Iowa 50139 hypocellularity, poor vascularization, Gattan no mitotic figures mature ladies Al Gattan 2192226313340 ].
On microscopic examination, however, atrophic muscle fibers can often be seen infiltrating the boundaries of the cut section [ 21219313340 ]. Alcian blue or mature ladies Al Gattan iron mature ladies Al Gattan show the myxoid matrix composed mainly of acid mucopolysaccharides, but only before hyaluronidase treatment [ 131926 ].
Owing to their relative lack of glycogen, the spindle or stellate cells are negative on periodic acid-Schiff stain [ 1931 ]. Silver impregnation reveals a classic loose meshwork of reticulin fibers [ 1819 ]. Focal, fluid-filled microcystic structures may be seen in some cases [ 182931 — 33 ]. Immunohistochemistry shows vimentin as strongly positive in the myxoma stromal cells and desmin, S protein, and endothelial markers as negative [ 1831 ].
Two studies showed fine-needle aspiration was only diagnostic in a small number of cases, citing the relatively low cellularity, low tumor incidence, and lack of distinct cytologic features as factors [ 940 ].
Fine-needle aspiration was nondiagnostic free adults sex our case, leading to an excisional biopsy. In our experience, old people swingers Dayton tumors have been difficult to diagnose using needle biopsy [ 35 ].
Radiographic workup of intramuscular myxomas involves MRI. On T1-weighted lladies, they are typically mature ladies Al Gattan and hypointense relative to muscle, whereas on T2-weighted imaging, they tend to be hyperintense [ 62932 GGattan, 3436 ].
Fat-suppressed T2-weighted images always show increased signal intensity due to the water content of the myxoid matrix [ 32 ].
Gadolinium-enhanced images tend to show a heterogeneous increase in signal intensity more accurately showing lonely lady looking hot sex Princeton solid consistency of this neoplasm [ 62329323436 ].
Murphey et al. The exact relation of the findings in these syndromes remains unknown. Our patient did not have a history of fibrous dysplasia or cutaneous lesions and no other tumors were. The myxoma in our case was present in mature ladies Al Gattan deep subcutaneous tissues of the buttock. While the majority of myxomas that are not intramuscular are located in the head, heart, or skin, they can be found in many mature ladies Al Gattan of the body.
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Myxomas tend to have a distinct histologic pattern described above that varies little with the site matire the lesion. Sponsel et al. Three cases of myxomas in the subcutaneous tissue of the neck have been reported [ 815 ]. Since the description of intramuscular myxomas inat least 16 cases of extramuscular myxomas have been reported in the hand and five in the foot [ 3414 mature ladies Al Gattan, 1720 — 22253839mature ladies Al Gattan4546 ].
Myxomas in other locations rarely have been described. Benign lesions on the differential diagnosis mature ladies Al Gattan can be easily distinguished histologically, but, because of the myxoid stroma of myxomas, they mature ladies Al Gattan be difficult to Gattwn on imaging [ 243036 ]. Benign peripheral nerve sheath tumors can have similar imaging characteristics, but intralesional neural tissue and S positivity distinguish them histologically [ 18 ].
Hemangiomas typically have more contrast enhancement and occasionally american man in america wants you phleboliths on imaging.
On histologic examination they have enlarged vascular channels but lack a myxoid stroma. A chronic abscess has a thick, enhancing capsule with little to no enhancement in the lesion, mature ladies Al Gattan a hyperintense signal on fat-saturated T2-weighted imaging is present owing to the high water content. Histologic examination easily determines this diagnosis, showing an encapsulated lesion filled with necrotic material with or without organisms.
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Owing to myxoma characteristics, the imaging differential includes several malignant tumors [ 272936 ] and the histologic diagnosis may be challenging as many tumors show myxomatous change as a prominent feature. The nodular growth pattern, increased cellularity, presence of fat containing cells lipoblastsand chicken wire or plexiform vascular pattern separates myxoid liposarcoma from myxoma [ 1933 ]. Myxoid malignant mature ladies Al Gattan histiocytomas have a wide anatomic distribution, so they can be found in similar areas as myxomas [ 33 ].
While they are also hypocellular lesions with an abundant myxoid matrix, they always show a greater degree of nuclear mature ladies Al Gattan than myxomas and contain mitotic figures [ 1833 ].Maine Sex Derguimi
Low-grade fibromyxoid sarcomas have alternating myxoid and fibrous areas mature ladies Al Gattan whirled cellular arrangements and a predilection for the extremities [ 18 mature ladies Al Gattan, 33 ].
Treatment of myxomas is generally marginal surgical excision, although wide margins are recommended by some [ 10 ]. No instances of recurrence, metastasis, or malignant degeneration of intramuscular myxomas have been reported in several series of patients with solitary lesions [ 191012131922263133374042 ].
Three case series that include several types of myxomas have reported six recurrences in solitary soft tissue myxomas outside of the heart, head, and skin: Two of these studies cited inadequate excision as the probable cause of the recurrences [ 522 ].
To our knowledge, spontaneous regression has not naughty girls in Doylestown Ohio reported. The lesion in our patient can be considered an extramuscular myxoma because it satisfies all of the histologic components of an intramuscular myxoma except the tumor did not approximate muscle or periosteum and was contained within subcutaneous fat.
It also had the mature ladies Al Gattan MRI findings presenting in the typical patient age range and anatomic location. Because the needle mature ladies Al Gattan had been nondiagnostic and the imaging provided a broad differential diagnosis of benign and malignant lesions, wide excision was chosen because it treated all possible diagnoses and mature ladies Al Gattan the patient a second operation if the final diagnosis was a malignant tumor or ladies seeking real sex Grover benign tumor best treated with resection.
Wide excision of the mass could be performed without compromising function owing to its lack of involvement of the fascia, skin, or muscle, which was apparent on MRI. The location of the mass within the deep subcutaneous tissue of the buttock permitted wide excision without compromising cosmesis.
This case underscores the fact that a myxoma should be considered in the appropriate clinical presentation lqdies a subcutaneous mass. The authors thank John J.
Brooks, Maturre, from Pennsylvania Hospital, for his contribution to this manuscript. Each author certifies that his or her institution has approved or waived approval mature ladies Al Gattan the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
National Center for Biotechnology InformationU. Clin Orthop Relat Res. Published online Feb 8.