Section of Orthopaedic Surgery, Department of Medicine, Fukuoka Dental College, Fukuoka, Japan.
Section of Orthopaedic Surgery, Department of Medicine, Fukuoka Dental College, Fukuoka, Japan
In Vivo. 2023 Jan-Feb;37(1):503-505. doi: 10.21873/invivo.13107.
BACKGROUND/AIM: Superficial angiomyxoma (SAM) is a rare benign soft-tissue tumor that usually occurs in the trunk, head and neck, and lower extremity of middle-aged adults. Herein, we describe an unusual case of SAM of the wrist, which was initially diagnosed as a ganglion cyst on imaging.
The patient was a 71-year-old man with no history of trauma who presented with a 2-year history of a palpable mass in the left wrist. Physical examination revealed a 2.5-cm, elastic hard, mobile, nontender mass. Magnetic resonance imaging revealed a well-defined mass with iso-signal intensity relative to skeletal muscle on T1-weighted sequences and very high signal intensity on T2-weighted fat-suppressed sequences. Subtle internal enhancement was seen following gadolinium administration. Complete excision was performed under general anesthesia with tourniquet control. Histologically, the lesion was composed of bland spindle to stellate-shaped cells in an abundant myxoid stroma. Immunohistochemically, the lesional cells were positive for CD34 but negative for S-100 protein, smooth-muscle actin, desmin, epithelial membrane antigen and pancytokeratin. These findings were consistent with a diagnosis of SAM. There was no clinical evidence of recurrence during a follow-up period of 3 months.
Although extremely rare, SAM should be considered in the differential diagnosis of a cyst-like solid lesion near small joints.
背景/目的:浅表性血管黏液瘤(SAM)是一种罕见的良性软组织肿瘤,通常发生于中老年人的躯干、头颈部和下肢。本文描述了腕部不常见的 SAM 病例,该病例最初在影像学上被诊断为腱鞘囊肿。
患者为 71 岁男性,无外伤史,左腕部有 2 年可触及肿块的病史。体格检查发现一个 2.5cm 大小、有弹性、坚硬、可移动、无触痛的肿块。磁共振成像显示边界清楚的肿块,在 T1 加权序列上与骨骼肌等信号强度,在 T2 加权脂肪抑制序列上信号强度非常高。钆造影后可见轻微的内部强化。在止血带控制下全身麻醉下进行完全切除。组织学上,病变由丰富黏液样基质中的温和梭形至星状细胞组成。免疫组化染色显示病变细胞 CD34 阳性,S-100 蛋白、平滑肌肌动蛋白、结蛋白、上皮膜抗原和广谱细胞角蛋白阴性。这些发现与 SAM 的诊断一致。在 3 个月的随访期间,无临床复发证据。
尽管极其罕见,但在临近小关节的囊性实性病变的鉴别诊断中应考虑 SAM。