Excision of myxoma from Hunters canal( medial thigh)
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In the WHO Classification of Tumours of Soft Tissue and Bone, myxomas are included in the section headed ‘Tumours of uncertain differentiation’. There are four main sub-types: acral fibromyxoma; intramuscular myxoma; juxta-articular myxoma; deep (aggressive) angiomyxoma. Of note myxoma may also occur in the heart or the eye. The most common sub-type encountered by the orthopaedic surgeon is the intramuscular myxoma. Patients present with a lump which may or may not be painful. Ultrasound scanning followed by MRI is recommended for investigation. Most centres dealing with soft tissue and bone tumours would recommend biopsy to confirm the diagnosis. A discussion can then ensue with the patient regarding excision if symptomatic. The main risks of excision include wound problems, infection, damage to adjacent critical structures and recurrence.
Intramucular myxomas are benign tumours of mesenchymal origin. The incidence is 1 in 1 million with a slight female preponderance of 57%. The typical age range of presentation is 40-70 years. 64% of patients will notice an enlarging mass, with the rest being incidental finding. 55% report that the tumour is painful. The size on presentation ranges from 1-17cm. They can be solitary or multiple. If they are multiple then the patient should be investigated for Mazabraud syndrome which features monostotic or polyostotic fibrous dysplasia.
It is important to note that if there is any doubt about the diagnosis, a biopsy must be performed to rule out a malignant tumour. There are no reports of malignant transformation of intramuscular myxomas. Therefore if the patient has none or minimal symptoms, non-operative management is recommended. If the patient is symptomatic then excision can be performed. Risks include damage to adjacent critical structures such as large nerve or blood vessels, wound problems, infection and recurrence rates of 30% at a median of 8.5 years.
Author:Mr Kenny Rankin FRCS (Tr & Orth)
Institution: The Freeman Hospital, Newcastle, UK.
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Question 1 of 15
Which one of the following types of myxoma is the orthopaedic surgeon most likely to come across?CorrectIncorrect
Question 2 of 15
Regarding the recurrence rate of intramuscular myxoma following excision which one of the following is correct?CorrectIncorrect
Question 3 of 15
Regarding the incidence of intramuscular myxoma which of one the following is correct?CorrectIncorrect
Question 4 of 15
Regarding the age range (in years) of presentation of intramuscular myxoma which of one the following is correct?CorrectIncorrect
Question 5 of 15
Regarding the percentage of patients presenting with pain from an intramuscular myxoma which one of the following is correct?CorrectIncorrect
Question 6 of 15
Regarding tissue of origin of intramuscular myxomas which of one the following is correct?CorrectIncorrect
Question 7 of 15
Which one of the following is the the most common location of intramuscular myxomas?CorrectIncorrect
Question 8 of 15
If a patient has multiple myxoma lesions the should be investigated for which one of these syndromes?CorrectIncorrect
Question 9 of 15
The syndrome that includes multiple myxomas also features which one of these types of lesion?CorrectIncorrect
Question 10 of 15
Investigation of a possible intramuscular myxoma includes which one of the following?CorrectIncorrect
Question 11 of 15
When an MRI report states appearances in keeping with intramuscular myxoma which one of the following is the correct next step?CorrectIncorrect
Question 12 of 15
In patients with a biopsy proven diagnosis of intramuscular myxoma which one of the following statements is correct?CorrectIncorrect
Question 13 of 15
Typical appearances of cells within an intramuscular myxoma include which one of the following?CorrectIncorrect
Question 14 of 15
The extra cellular matrix of intramuscular myxomas consists of which one of the following?CorrectIncorrect
Question 15 of 15
Intramuscular myxomas are formally classified along with other types of bone and soft tissue tumour by which one of the following organisations?CorrectIncorrect