Transcript Diapositiva 1 - Siapec

IUXTA-ARTICULAR MYXOMA : A CASE REPORT
NUNZIA SCIBETTA - LORENZO MARASA’
Department of Pathology, A.R.N.A.S. Civico, Palermo
INTRODUCTION
 Iuxta-articular myxoma (JAM), is a rare, benign soft
tissue tumor that usually arises in the vicinity of a
large joint ( knee, shoulder, elbow, ankle), and has
histological features resembling a cellular myxoma.
 The patients ranged in age from 16 to 83 years and
present with a swelling or a mass that can be painful or
tender.
 Radiographic studies show a soft tissue mass that has
similar imaging characteristics as intramuscular
myxoma.
 We report a case of JAM situated in the vicinity of a left
temporo-mandibolare joint, because no cases has
been reported before, in this seat, in the pathology
literature.
METHODS
 A 68 year old man underwent conservative excision of
a enlarging, painful mass, arising in the vicinity of a left
temporo-mandibular joint.
 No history of trauma or surgery was reported.
 The surgical specimen was fixed in buffered formalin,
embedded in paraffin and stained with H&E. Histochemical (colloidal iron, alcian-blue and mucicarmine
stains for stromal mucins (glycosaminoglycans), and
immunohistochemical studies were performed.
RESULTS
 Grossly the lesion of 3 cm of maximum diameter, was
myxoid, soft, yellow-tan, and involved the subcutaneous adipose tissue.
 Histologically the lesion showed loosely arranged spindled fibroblast-like cells suspended in an abundant hypovascular, rich myxoid matrix.
 No cystic, ganglion-like spaces were seen.
 Mitotic figures and necrosis are absent
 The periphery of the tumor showed ill defined boundaries.
 Colloidal iron, alcian blue and mucicarmine stains for
stromal mucins confirmed the abundance of glycosaminoglycans in the myxoid matrix, and the spindled cells
showed staining for CD34, vimentin, and no staining for
S100 protein, desmin and actin.
1
2
2
Bland appearing spindle cells embedded in a hypovascular myxoid
stroma
JAM composed of fibroblast-like
cells with hyperchromatic nuclei and
delicate cytoplasmic processes
1
2
2
Cells with small cytoplasmic vacuoles containing mucinous material,
mild nuclear pleomorphism and hyperchromasia
Multiple small cystic spaces and
clefts are seen in the myxoid stroma
1
2
2
1 . Immunohistochemically the cells
stain for CD34
2 . There is no staining for desmin
3
3 . There is no staining for S100 protein
CONCLUSIONS
 The our lesion involved the subcutaneous adipose
tissue in a man and presented as an enlarging, painful
mass in the region of temporo-mandibular joint.
 Microscopically bears a close resemblance to intramuscular myxoma , but there are certain clinical and microscopic differences between this lesion and JAM,
because intramuscular myxoma tend to affect woman
and occur primarly in the large muscles of the body,
and tipically do not recur even when incompletely excised.
CONCLUSIONS
 JAM is likely a proliferative fibroblastic process with
excess extracellular mucin formation as seen in
intramuscular myxoma, early forms of ganglion cysts,
and also in nodular fasciitis, another presumably
reactive proliferation of fibroblasts.
 JAM is a benign condition despite its frequent large
size, its infiltrative growth pattern. Therefore complete
conservative excision is the optimal treatment.
MAIN REFERENCE
Meis J.M., Enzinger F. : Juxta-articular myxoma. A
Clinical and Pathologic Study of 65 cases. Human
Pathol 23; 639-646; 1992