FDG PET/CT and MR imaging of intramuscular myxoma in the gluteus maximus
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CASE REPORT
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
FDG PET/CT and MR imaging of intramuscular myxoma in the gluteus maximus Jun Nishio* and Masatoshi Naito
Abstract Intramuscular myxoma is a rare benign soft tissue tumor which may be mistaken for other benign and low-grade malignant myxoid neoplasms. We present the case of a 63-year-old woman with an asymptomatic intramuscular myxoma discovered incidentally on a whole-body F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography. PET images showed a mild FDG uptake (maximum standardized uptake value, 1.78) in the left gluteus maximus. Subsequent magnetic resonance (MR) imaging revealed a well-defined ovoid mass with homogenous low signal intensity on T1-weighted sequences and markedly high signal intensity on T2-weighted sequences. Contrast-enhanced MR images showed heterogeneous enhancement throughout the mass. The diagnosis of intramuscular myxoma was confirmed on histopathology after surgical excision of the tumor. The patient had no local recurrence at one year follow-up. Our case suggests that intramuscular myxoma should be considered in the differential diagnosis of an oval-shaped intramuscular soft tissue mass with a mild FDG uptake. Keywords: FDG, intramuscular myxoma, MRI, PET/CT
Background Intramuscular myxoma is a rare benign soft tissue tumor of unknown origin. It usually occurs as an isolated lesion. The coexistence of intramuscular myxoma and skeletal fibrous dysplasia is known as Mazabraud’s syndrome [1]. To the best of our knowledge, F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) findings of intramuscular myxoma have been mentioned in one prior publication [2]. Here, we describe a case of intramuscular myxoma with a mild FDG uptake and discuss its clinicopathologic and radiologic features. Case presentation A 63-year-old previously healthy woman underwent whole body FDG PET/CT for cancer screening. FDG PET images demonstrated an increased uptake in the left buttock. The maximum standardized uptake value (SUV) was 1.78. CT showed a 3.5 cm hypodense mass, with corresponding tracer uptake (Figure 1). Physical examination did not show any abnormality in her left buttock. Laboratory findings were within normal limits. Subsequent magnetic resonance imaging (MRI) demonstrated * Correspondence: [email protected] Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
a well-defined soft tissue mass in the left gluteus maximus. The mass showed homogenous low signal intensity on T1weighted images (Figure 2A) and markedly high signal intensity on T2-weighted images (Figure 2B). A thin rim of higher signal intensity approaching that of fat was seen around the mass on T1-weighted images. Contrastenhanced T1-weighted images revealed heterogenous enhancement throughout the mass (Figure 2C). Based on these findings, benign and low-grade malignant myxoid neoplasms were suspected, including intramuscular
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