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The relevance of the margin of excision in a rare benign tumour: a case report of recurrent myxoma of the gluteal muscle in a resource limited setting.

Roland Cheofor Ngu

Background: Myxomas are benign neoplasms derived from connective tissue which can be found within large muscle groups. The most frequent location of intramuscular myxoma is the thigh muscles. These tumours often grow locally without distant metastases and may recur if not properly excised with a good margin of excision. Thus, the aim of this case is to illustrate the relevance, consequence and solution of a poorly excised intramuscular myxoma. Case presentation: A 41 year old African female who presented at our surgical unit, following referral for excision of a painless left gluteal mass. Physical examination revealed a lateral left buttock mass, measuring 8 cm by 6 cm, firm, non-tender and slightly. Computerized Tomography (CT) scan showed a homogenous mass of the gluteal muscle and histopathological studies revealed an intramuscular myxoma. Management was by surgical excision with imprecise margin of excision. Two months following surgery, the mass recurred with similar symptoms necessitating a second excision but this time with a 2 cm surgical margin of and a 2nd biopsy which reaffirm an intramuscular myxoma. The patient was then placed on analgesics and physiotherapy following surgery. No recurrence was noted after this. Conclusion: Myxomas are a rare group of benign neoplasm. Diagnosis is only confirmed by biopsy after excision and management is essentially by thorough surgical excision with a wide margin of excision without which there is a chance of recurrence. We therefore recommend thorough surgical excision of intramuscular myxomas with at least a 2 cm surgical margin in order to prevent recurrence.