Monday, February 4, 2013

Lateral Neck Myxoma

November 2011, I noticed a lump on my neck that was sore.  I went to the doctor and was referred to a general surgeon who diagnosed the lump as lipoma.  She conducted what she thought would be routine surgery in February 2012, but could not find the mass.  A couple weeks later, I had an MRI that showed a persistent oval-shaped lobulated soft tissue mass arising deep to the distal right trapezius muscle and 3.8 x 1.5 x 2.2cm in size.  I just recently had another MRI done (almost 1 year later) and the mass has not changed in size or position.  The radiologist suggests that this may be myxoma.  My doctor was confused as this usually occurs in the heart.  She recommended I go to the a specific cancer center for a 2nd expert opinion from their sarcoma team.  I did some research today on my own and found a presentation on Lateral Neck Myxomas at the Head and Neck Tumor Conference.  I saw that there were many similarities between what the radiologist noted in my MRI's and his presentation.  For example the heterogenerous appearance, mistake for lipoma and slight enhancement displayed in MRI on T2 weighted image.  I was hoping that maybe you could let me know if this was something you had experience working with or had any advice for me in the next steps.  My doctor seems to be concerned with the location of the mass as it would require going through the trapezius muscle to remove or possibly even obtain a sample. Any guidance or insight would be greatly appreciated!

Patrick Ha, MD FACS replies...

The appearance of lipomas can be quite variable, and the radiologist will often bring up the fact that a heterogeneous appearance on MRI can be a sign of something more than just a straightforward lipoma, though this is not always the case.  Given the appearance, one option would be to obtain a needle biopsy under radiographictrapezius muscle.  Despite this, it should be resectable, and this would provide the ultimate sampling and determine whether any further therapy would be necessary.

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