Tafti Dawood A, Dearborn Micheal C, Ornoff Ashley, Moeck Adam R, Cecava Nathan D
Department of Radiology, San Antonio Military Medical Center, San Antonio, TX, USA.
Department of Radiology, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA.
Am J Case Rep. 2021 Apr 5;22:e927922. doi: 10.12659/AJCR.927922.
BACKGROUND This report is of a nerve sheath myxoma presenting as a slow-growing mass in the back of the left ankle of a 36-year-old man that was investigated by ultrasound and magnetic resonance imaging (MRI) before the diagnosis was confirmed by histopathology. CASE REPORT We report a nerve sheath myxoma of the ankle in a 36-year-old man. The palpable abnormality was falsely assumed to be a ganglion cyst prior to advanced imaging. Magnetic resonance imaging demonstrated a lobular mass with high T2 and intermediate T1 signal as well as moderate enhancement. T2 sequences also demonstrated distinctive internal septae. These internal septae were also noted on sonographic evaluation prior to biopsy. The patient was treated with surgical excision, and pathologic analysis showed myxoid nodules with loose arrangements of spindled cells separated by fibrous septae. S-100 protein and glial fibrillary acidic protein positivity by immunohistochemistry staining was demonstrated. Follow-up imaging at 12 months showed no evidence of tumor recurrence. CONCLUSIONS This case highlights that while nerve sheath myxomas are rare tumors, they should be considered in cases of cutaneous soft-tissue masses with myxoid imaging features. Ultrasound and magnetic resonance imaging features of thin internal septae may be present and correspond well with the unique histopathological characteristics of these lesions. This report shows the importance of imaging of peripheral soft-tissue masses, including ultrasound and MRI, which can identify localized and benign features and the solid, cystic, and myxoid areas, which were characteristic in this case of benign nerve sheath myxoma.
背景 本报告介绍了一名36岁男性左踝后部出现的神经鞘黏液瘤，该肿瘤生长缓慢，在组织病理学确诊之前进行了超声和磁共振成像（MRI）检查。病例报告 我们报告了一名36岁男性踝部的神经鞘黏液瘤。在进行高级成像之前，可触及的异常被误诊为腱鞘囊肿。磁共振成像显示一个小叶状肿块，T2信号高，T1信号中等，且有中度强化。T2序列还显示出独特的内部间隔。在活检前的超声评估中也发现了这些内部间隔。患者接受了手术切除，病理分析显示为黏液样结节，梭形细胞排列疏松，被纤维间隔分隔。免疫组织化学染色显示S-100蛋白和胶质纤维酸性蛋白呈阳性。12个月的随访成像显示无肿瘤复发迹象。结论 本病例强调，虽然神经鞘黏液瘤是罕见肿瘤，但在具有黏液样影像学特征的皮肤软组织肿块病例中应考虑到该肿瘤。薄的内部间隔的超声和磁共振成像特征可能存在，且与这些病变独特的组织病理学特征相符。本报告显示了外周软组织肿块成像（包括超声和MRI）的重要性，其可识别局部和良性特征以及实性、囊性和黏液样区域，这些在本例良性神经鞘黏液瘤中具有特征性。
