J Korean Neurosurg Soc.  2015 Dec;58(6):566-570. 10.3340/jkns.2015.58.6.566.

Atypical Intramuscular Myxoma of the Lumbosacral Paraspinal Muscle: The First Case Report in Asian

• Choi DY
• Kim JT
• Kim J
• Lee HJ

• KMID: 2151163
• DOI: http://doi.org/10.3340/jkns.2015.58.6.566

Abstract

Intramuscular myxoma (IM) is a benign neoplasm of mesenchymal origin. We report a rare case of IM which was located in the lumbosacral paraspinal muscles. A 62-year-old female patient presented with progressive low back pain for 2 months, and the radiologic findings showed a large mass (4.0x3.5x6.5 cm) in the right lumbosacral paraspinal area. Total resection of the tumor was performed and the symptom was nearly resolved after surgery. Although the immuno-histopathological analysis was consistent with IM, there were some different findings from typical pathological characteristics of IM in this case. Firstly, the symptomatic change of the mass took relatively short time (less than 3 months), and this change was accompanied by partial calcification inside the mass. Moreover, iatrogenic interruption of paravertebral muscle by the other previous operation might be the promoting factor of the fibrous dysplasia, which can explain the pathogenesis of IM. To our knowledge, this is the eighth case of the lumbar paraspinal myxoma reported in the literatures and the first case in Asian population.

Keyword

Myxoma; Intramuscular myxoma; Paraspinal muscle; Calcification

MeSH Terms

Asian Continental Ancestry Group*
Female
Humans
Low Back Pain
Middle Aged
Myxoma*
Paraspinal Muscles*

Figure

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  Fig. 1 Preoperative magnetic resonance images. The multi-lobulated mass was located within the right lumbosacral paraspinal muscles in contact with the posterior elements of the lumbosacral vertebra. This large mass measured approximately 4.0×3.5×6.5 cm in size, and the lesion was hypointense on T1-weighted images (B) and hyperintense on T2-weighted images (A and D). On the post-contrast images (C and E), there was heterogenously enhancing foci inside the mass with peripheral and septal enhancement.

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  Fig. 2 Comparing the preoperative lumbar spine CT (A and B) with the previous abdominal CT (C and D). Note that the calcification in the inferior portion of the mass (A and B), which was not detected on the abdominal CT examined 4 months ago.

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  Fig. 3 Intraoperative photographs. The mass was identified through a paramedian longitudinal incision and was excised en bloc. Partial calcification was detected inside the tumor (asterisks).

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  Fig. 4 Microscopic findings of the paraspinal myxomas. A : Myxoid hypocelluar lesion with fibrous capsule (circle). Note the microcystic change in mass (star). Degenerated skeletal muscle fiber (square) also identified (H&E, ×40). B : Bland-looking spindle to stellate cells in bluish myxoid stroma. Note the pyknotic nuclei and microcalcification (arrow) (H&E, ×200). C : Numerous karyorrhectic nuclei (circle) and microcalcification (arrow) in periphery-capsular area of tumor, which was seen in CT (H&E, ×40). D : Numerous karyorrhectic nuclei and microcalcification (arrow) in periphery-capsular area of tumor (H&E, ×200).

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