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Imaging of Soft-Tissue Myxoma with Emphasis on CT and MR and Comparison of Radiologic and Pathologic Findings¹

¹ From the Depts of Radiologic Pathology (M.D.M., G.A.M.) and Soft Tissue Pathology (J.F.S.), Armed Forces Inst of Pathology, 6825 16th St NW, Bldg 54, Rm M-127A, Washington, DC 20306; Depts of Radiology and Nuclear Med (M.D.M.) and Surgery (H.T.T.), Uniformed Services Univ of the Health Sciences, Bethesda, Md; Dept of Radiology, Univ of Maryland School of Med, Baltimore (M.D.M.); Dept of Surgery, Orthopedic Service, Walter Reed Army Med Ctr, Washington, DC (H.T.T.); and Sinai Hospital, Cancer Institute, Baltimore, Md (A.M.L., A.J.A.). From the 1997 RSNA scientific assembly. Received Oct 3, 2001; revision requested Dec 18; revision received Mar 27, 2002; accepted Apr 19. Address correspondence to M.D.M. (e-mail: murphey@afip.osd.mil).

View larger version (91K): [in a new window]   Figure 1. Intramuscular myxoma of the vastus medialis muscle in an 84-year-old woman with a rapidly enlarging distal thigh mass. Anteroposterior radiograph of the distal thigh shows a nonspecific soft-tissue mass (arrowheads).

View larger version (133K): [in a new window]   Figure 2. Intramuscular myxoma of the vastus intermedius muscle in a 69-year-old man with a painful slow-growing mass of the upper thigh. Anterior delayed bone scintigram of the upper thigh shows mild homogeneous radionuclide uptake (arrow).

View larger version (123K): [in a new window]   Figure 3. Intramuscular myxoma of the vastus medialis muscle in a 62-year-old man with a painless mass not changing in size. Anteroposterior arteriogram of the distal thigh shows no tumor staining but reveals displacement of vessels (arrowheads) around the soft-tissue mass.

View larger version (159K): [in a new window]   Figure 4a. Intramuscular myxoma of the deltoid muscle in a 52-year-old man with a painless mass not changing in size. (a) Transverse gradient-echo (repetition time msec/echo time msec, 130/1.7; 60° flip angle) MR image obtained after intravenous administration of gadolinium chelate shows peripheral (thick wall) and nodular (arrowheads) enhancement posteriomedially and a small cystic focus (arrows) anterolaterally with a thin rim of enhancement. (b) Transverse Doppler US image shows a hypoechoic solid heterogeneous mass (arrows) with posterior acoustic enhancement and a small anechoic cyst component (*). Vessels (arrowheads) are seen prominently at the lesion margin; some are also seen within the lesion. (c) Photomicrograph reveals a cystic component (c), solid myxomatous component (m), pseudocapsule (arrow), and mild fat atrophy (*) in the surrounding muscle. (Hematoxylin-eosin stain; original magnification, x150.)

View larger version (161K): [in a new window]   Figure 4b. Intramuscular myxoma of the deltoid muscle in a 52-year-old man with a painless mass not changing in size. (a) Transverse gradient-echo (repetition time msec/echo time msec, 130/1.7; 60° flip angle) MR image obtained after intravenous administration of gadolinium chelate shows peripheral (thick wall) and nodular (arrowheads) enhancement posteriomedially and a small cystic focus (arrows) anterolaterally with a thin rim of enhancement. (b) Transverse Doppler US image shows a hypoechoic solid heterogeneous mass (arrows) with posterior acoustic enhancement and a small anechoic cyst component (*). Vessels (arrowheads) are seen prominently at the lesion margin; some are also seen within the lesion. (c) Photomicrograph reveals a cystic component (c), solid myxomatous component (m), pseudocapsule (arrow), and mild fat atrophy (*) in the surrounding muscle. (Hematoxylin-eosin stain; original magnification, x150.)

View larger version (111K): [in a new window]   Figure 4c. Intramuscular myxoma of the deltoid muscle in a 52-year-old man with a painless mass not changing in size. (a) Transverse gradient-echo (repetition time msec/echo time msec, 130/1.7; 60° flip angle) MR image obtained after intravenous administration of gadolinium chelate shows peripheral (thick wall) and nodular (arrowheads) enhancement posteriomedially and a small cystic focus (arrows) anterolaterally with a thin rim of enhancement. (b) Transverse Doppler US image shows a hypoechoic solid heterogeneous mass (arrows) with posterior acoustic enhancement and a small anechoic cyst component (*). Vessels (arrowheads) are seen prominently at the lesion margin; some are also seen within the lesion. (c) Photomicrograph reveals a cystic component (c), solid myxomatous component (m), pseudocapsule (arrow), and mild fat atrophy (*) in the surrounding muscle. (Hematoxylin-eosin stain; original magnification, x150.)

View larger version (137K): [in a new window]   Figure 5a. Intramuscular myxoma of the vastus intermedius muscle in a 66-year-old man with a painless slow-growing mass. (a) Transverse CT image shows a homogeneous low-attenuating intramuscular mass (arrow) with a small rim of surrounding fat (arrowheads). (b) Transverse CT image obtained at the superior margin of the myxoma reveals a larger cap of fat (arrowhead). (c) Sectioned gross pathologic specimen shows that the myxoma has a surrounding pseudocapsule (arrow), a cap of fat (*) superiorly and inferiorly, and a small amount of fat (arrowhead) in the surrounding rim of muscle.

View larger version (138K): [in a new window]   Figure 5b. Intramuscular myxoma of the vastus intermedius muscle in a 66-year-old man with a painless slow-growing mass. (a) Transverse CT image shows a homogeneous low-attenuating intramuscular mass (arrow) with a small rim of surrounding fat (arrowheads). (b) Transverse CT image obtained at the superior margin of the myxoma reveals a larger cap of fat (arrowhead). (c) Sectioned gross pathologic specimen shows that the myxoma has a surrounding pseudocapsule (arrow), a cap of fat (*) superiorly and inferiorly, and a small amount of fat (arrowhead) in the surrounding rim of muscle.

View larger version (137K): [in a new window]   Figure 5c. Intramuscular myxoma of the vastus intermedius muscle in a 66-year-old man with a painless slow-growing mass. (a) Transverse CT image shows a homogeneous low-attenuating intramuscular mass (arrow) with a small rim of surrounding fat (arrowheads). (b) Transverse CT image obtained at the superior margin of the myxoma reveals a larger cap of fat (arrowhead). (c) Sectioned gross pathologic specimen shows that the myxoma has a surrounding pseudocapsule (arrow), a cap of fat (*) superiorly and inferiorly, and a small amount of fat (arrowhead) in the surrounding rim of muscle.

View larger version (145K): [in a new window]   Figure 6a. Intramuscular myxoma of the gluteal muscles in a 14-year-old boy. Transverse CT images obtained (a) before and (b) after intravenous administration of contrast material show a low-attenuating intramuscular mass (*) with faint peripheral and septal enhancement (arrowheads) and a small focus of nodularity (arrow). No pseudocapsule is seen.

View larger version (148K): [in a new window]   Figure 6b. Intramuscular myxoma of the gluteal muscles in a 14-year-old boy. Transverse CT images obtained (a) before and (b) after intravenous administration of contrast material show a low-attenuating intramuscular mass (*) with faint peripheral and septal enhancement (arrowheads) and a small focus of nodularity (arrow). No pseudocapsule is seen.

View larger version (125K): [in a new window]   Figure 7a. Intramuscular myxoma of the gluteal muscles in a 40-year-old man with a painless slowly enlarging mass. (a, b) Transverse T1-weighted (416/17) MR images obtained (a) before and (b) after intravenous administration of gadolinium chelate reveal a low-signal-intensity intramuscular mass (* in a) with an incomplete rim of fat laterally (arrowheads in a). The contrast-enhanced image shows two distinct areas, with moderate diffuse enhancement of the myxoma medially (black *) and thin peripheral enhancement of the cyst laterally (white *). The peripheral enhancement around the entire lesion represents the pseudocapsule (arrows). (c) Transverse T2-weighted (3,850/135) MR image reveals diffuse high signal intensity in both components separated by a septum of low signal intensity (arrow). (d) Sectioned gross pathologic specimen shows the myxoma (*), the cystic component (arrowheads), and the pseudocapsule (arrows); this appearance corresponds to the imaging findings.

View larger version (130K): [in a new window]   Figure 7b. Intramuscular myxoma of the gluteal muscles in a 40-year-old man with a painless slowly enlarging mass. (a, b) Transverse T1-weighted (416/17) MR images obtained (a) before and (b) after intravenous administration of gadolinium chelate reveal a low-signal-intensity intramuscular mass (* in a) with an incomplete rim of fat laterally (arrowheads in a). The contrast-enhanced image shows two distinct areas, with moderate diffuse enhancement of the myxoma medially (black *) and thin peripheral enhancement of the cyst laterally (white *). The peripheral enhancement around the entire lesion represents the pseudocapsule (arrows). (c) Transverse T2-weighted (3,850/135) MR image reveals diffuse high signal intensity in both components separated by a septum of low signal intensity (arrow). (d) Sectioned gross pathologic specimen shows the myxoma (*), the cystic component (arrowheads), and the pseudocapsule (arrows); this appearance corresponds to the imaging findings.

View larger version (134K): [in a new window]   Figure 7c. Intramuscular myxoma of the gluteal muscles in a 40-year-old man with a painless slowly enlarging mass. (a, b) Transverse T1-weighted (416/17) MR images obtained (a) before and (b) after intravenous administration of gadolinium chelate reveal a low-signal-intensity intramuscular mass (* in a) with an incomplete rim of fat laterally (arrowheads in a). The contrast-enhanced image shows two distinct areas, with moderate diffuse enhancement of the myxoma medially (black *) and thin peripheral enhancement of the cyst laterally (white *). The peripheral enhancement around the entire lesion represents the pseudocapsule (arrows). (c) Transverse T2-weighted (3,850/135) MR image reveals diffuse high signal intensity in both components separated by a septum of low signal intensity (arrow). (d) Sectioned gross pathologic specimen shows the myxoma (*), the cystic component (arrowheads), and the pseudocapsule (arrows); this appearance corresponds to the imaging findings.

View larger version (165K): [in a new window]   Figure 7d. Intramuscular myxoma of the gluteal muscles in a 40-year-old man with a painless slowly enlarging mass. (a, b) Transverse T1-weighted (416/17) MR images obtained (a) before and (b) after intravenous administration of gadolinium chelate reveal a low-signal-intensity intramuscular mass (* in a) with an incomplete rim of fat laterally (arrowheads in a). The contrast-enhanced image shows two distinct areas, with moderate diffuse enhancement of the myxoma medially (black *) and thin peripheral enhancement of the cyst laterally (white *). The peripheral enhancement around the entire lesion represents the pseudocapsule (arrows). (c) Transverse T2-weighted (3,850/135) MR image reveals diffuse high signal intensity in both components separated by a septum of low signal intensity (arrow). (d) Sectioned gross pathologic specimen shows the myxoma (*), the cystic component (arrowheads), and the pseudocapsule (arrows); this appearance corresponds to the imaging findings.

View larger version (163K): [in a new window]   Figure 8. Intramuscular myxoma of the peroneus longus muscle in a 33-year-old woman with a painful slow-growing mass. Sagittal T1-weighted (500/14) MR image shows a homogeneous low-signal-intensity soft-tissue mass (*) with focal areas of tissue around the lesion rim (arrows) similar in appearance to fat. Caps of more prominent fat (arrowheads) are also seen at the superior and inferior margins.

View larger version (139K): [in a new window]   Figure 9a. Intramuscular myxoma of the flexor carpi radialis muscle in a 34-year-old woman with a painless slowly enlarging forearm mass. (a) Sagittal T1-weighted (500/20) MR image shows a mass (*) of intermediate signal intensity (similar to that of muscle) with a rim (straight arrows) of tissue of higher signal intensity (approaching that of fat) and thicker caps of this tissue at the superior and inferior margins (curved arrows). (b) Sagittal gradient-echo (620/25, 25° flip angle) T2*-weighted MR image reveals homogeneous high signal intensity in the myxoma (*) and surrounding edema (arrowheads). (c) Photomicrograph shows the myxoma (*), pseudocapsule (solid arrows), and surrounding edema and muscle atrophy (area between open arrows). (Hematoxylin-eosin stain; original magnification, x150.)

View larger version (139K): [in a new window]   Figure 9b. Intramuscular myxoma of the flexor carpi radialis muscle in a 34-year-old woman with a painless slowly enlarging forearm mass. (a) Sagittal T1-weighted (500/20) MR image shows a mass (*) of intermediate signal intensity (similar to that of muscle) with a rim (straight arrows) of tissue of higher signal intensity (approaching that of fat) and thicker caps of this tissue at the superior and inferior margins (curved arrows). (b) Sagittal gradient-echo (620/25, 25° flip angle) T2*-weighted MR image reveals homogeneous high signal intensity in the myxoma (*) and surrounding edema (arrowheads). (c) Photomicrograph shows the myxoma (*), pseudocapsule (solid arrows), and surrounding edema and muscle atrophy (area between open arrows). (Hematoxylin-eosin stain; original magnification, x150.)

View larger version (131K): [in a new window]   Figure 9c. Intramuscular myxoma of the flexor carpi radialis muscle in a 34-year-old woman with a painless slowly enlarging forearm mass. (a) Sagittal T1-weighted (500/20) MR image shows a mass (*) of intermediate signal intensity (similar to that of muscle) with a rim (straight arrows) of tissue of higher signal intensity (approaching that of fat) and thicker caps of this tissue at the superior and inferior margins (curved arrows). (b) Sagittal gradient-echo (620/25, 25° flip angle) T2*-weighted MR image reveals homogeneous high signal intensity in the myxoma (*) and surrounding edema (arrowheads). (c) Photomicrograph shows the myxoma (*), pseudocapsule (solid arrows), and surrounding edema and muscle atrophy (area between open arrows). (Hematoxylin-eosin stain; original magnification, x150.)