Proliferative Myositis: Difference between revisions

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== Definition/Description [[Image:Neck.jpg|frame|right|275x185px]][[Image:Neck ct.jpg|frame|right]]  ==
== Definition/Description [[Image:SCM.jpg|frame|right|]][[Image:Neck ct.jpg|frame|right]]  ==


Proliferative myositis (PM)&nbsp;is a benign tumor which grows in skeletal muscle<ref name="Fauser et. al">Fauser C, Nahrig J, Niedermeyer H, Arnold W. Proliferative myositis: a rare pseudomalignant tumor of the head and neck. Archives of Otolaryngology - Head &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Neck Surgery [serial on the Internet]. (2008, Apr), [cited March 16, 2011]; 134(4): 437-440. Available from: CINAHL with Full Text.</ref>. It is usually 3-4 cm in diameter<ref name="Stanford" />, and is often mistaken for sarcomas (especially rhabdomyosarcoma)<ref name="Meis et. al">Meis J, Enzinger F. Proliferative fasciitis and myositis of childhood. The American Journal Of Surgical Pathology [serial on the Internet]. (1992, Apr), [cited March 16, 2011]; 16(4): 364-372. Available from: MEDLINE.</ref>.&nbsp; The tumor is formed by ganglion-like cells, fibroblasts, and myofibroblasts which increase the spaces between muscle fibers<ref name="Stanford" />.&nbsp; While etiology is unknown, it may result from injury to the muscle, fascia, or vasculature (resulting in ischemia) of the associated area<ref name="Dent et. al">Dent C, DeBoom G, Hamlin M. Proliferative myositis of the head and neck. Report of a case and review of the literature. Oral Surgery, Oral Medicine, And Oral Pathology [serial on the Internet]. (1994, Sep), [cited March 16, 2011]; 78(3): 354-358. Available from: MEDLINE.</ref>.&nbsp; PM generally presents in the upper extremity or trunk regions<ref name="Stanford" />.&nbsp; Median age of onset is 50 years<ref name="Mulier et. al" />, with rare cases reported in children<ref name="Stanford">Stanford University. Proliferative Myositis. Available at http://surgpathcriteria.stanford.edu/softfib/proliferative_myositis/printable.html. Accessed April 4, 2011</ref>.
Proliferative myositis (PM)&nbsp;is a benign tumor which grows in skeletal muscle<ref name="Fauser et. al">Fauser C, Nahrig J, Niedermeyer H, Arnold W. Proliferative myositis: a rare pseudomalignant tumor of the head and neck. Archives of Otolaryngology - Head &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Neck Surgery [serial on the Internet]. (2008, Apr), [cited March 16, 2011]; 134(4): 437-440. Available from: CINAHL with Full Text.</ref>. It is usually 3-4 cm in diameter<ref name="Stanford" />, and is often mistaken for sarcomas (especially rhabdomyosarcoma)<ref name="Meis et. al">Meis J, Enzinger F. Proliferative fasciitis and myositis of childhood. The American Journal Of Surgical Pathology [serial on the Internet]. (1992, Apr), [cited March 16, 2011]; 16(4): 364-372. Available from: MEDLINE.</ref>.&nbsp; The tumor is formed by ganglion-like cells, fibroblasts, and myofibroblasts which increase the spaces between muscle fibers<ref name="Stanford" />.&nbsp; While etiology is unknown, it may result from injury to the muscle, fascia, or vasculature (resulting in ischemia) of the associated area<ref name="Dent et. al">Dent C, DeBoom G, Hamlin M. Proliferative myositis of the head and neck. Report of a case and review of the literature. Oral Surgery, Oral Medicine, And Oral Pathology [serial on the Internet]. (1994, Sep), [cited March 16, 2011]; 78(3): 354-358. Available from: MEDLINE.</ref>.&nbsp; PM generally presents in the upper extremity or trunk regions<ref name="Stanford" />.&nbsp; Median age of onset is 50 years<ref name="Mulier et. al" />, with rare cases reported in children<ref name="Stanford">Stanford University. Proliferative Myositis. Available at http://surgpathcriteria.stanford.edu/softfib/proliferative_myositis/printable.html. Accessed April 4, 2011</ref>.


== Prevalence<br> ==
== Prevalence<br> ==

Revision as of 04:32, 6 April 2011

 

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Definition/Description
File:SCM.jpg
File:Neck ct.jpg
[edit | edit source]

Proliferative myositis (PM) is a benign tumor which grows in skeletal muscle[1]. It is usually 3-4 cm in diameter[2], and is often mistaken for sarcomas (especially rhabdomyosarcoma)[3].  The tumor is formed by ganglion-like cells, fibroblasts, and myofibroblasts which increase the spaces between muscle fibers[2].  While etiology is unknown, it may result from injury to the muscle, fascia, or vasculature (resulting in ischemia) of the associated area[4].  PM generally presents in the upper extremity or trunk regions[2].  Median age of onset is 50 years[5], with rare cases reported in children[2].

Prevalence
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Characteristics/Clinical Presentation    [edit | edit source]

  • Rapidly enlarging, solid tumor within skeletal muscle
  • Localized inflammation
  • No lymph node enlargement
  • No significant laboratory results

Associated Co-morbidities[edit | edit source]

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Medications[edit | edit source]

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Diagnostic Tests/Lab Tests/Lab Values[2][edit | edit source]

Proliferative Myositis is diagnosed based on biopsy.  The following list, taken directly from the Stanford University School of Medicine page on PM, are histologic and immunologic characteristics of PM which are used in its diagnosis:

o Relatively normal muscle fibers separated by expanded myxoid connective tissue
    o Produces distinctive checkerboard pattern
    o No evidence of muscle damage 
       o No sarcolemmal proliferation 
       o No multinucleation 
       o No nuclear enlargement 
       o No necrosis 
o Connective tissue space between fibers contains reactive cells resembling those seen in nodular fasciitis and proliferative fasciitis
    o Spindled and stellate fibroblasts and myofibroblasts 
       o Vesicular nuclei 
       o No cytologic atypia 
       o Actin positive 
       o CD68 variable 
       o S100, desmin negative 
    o Ganglion-like cells 
       o Characteristic feature of this process 
       o Large round regular nuclei 
       o Occasional binucleate and trinucleate cells may be seen 
       o Prominent nucleoli 
       o Dispersed chromatin 
       o Basophilic to amphophilic cytoplasm 
       o May be clustered and may mold each other 
       o Factor XIIIa positive 
       o Actin, CD68 negative to focal/weak 
       o Desmin, keratin, S100, neuron specific enolase negative 
    o Mitotic figures frequent 
       o No atypical mitotic figures

Etiology/Causes[edit | edit source]

While etiology is unknown, PM may result from injury to the muscle, fascia, or vasculature (resulting in ischemia) of the associated area[4]. 

Systemic Involvement[edit | edit source]

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Medical Management (current best evidence)[edit | edit source]

Surgical excision (recurrence following excision is rare)[2]

Physical Therapy Management (current best evidence)[edit | edit source]

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Alternative/Holistic Management (current best evidence)[edit | edit source]

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Differential Diagnosis[5][3][2][edit | edit source]

  • Myositis Ossificans
  • Neoplasms (especially rhabdomyosarcomas)
  • Proliferative fasciitis
  • Nodular fasciitis
  • Fibromatosis
  • Ganglioneuroblastoma or ganglioneuroma

Case Reports/ Case Studies[edit | edit source]

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Resources
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Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

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  1. ↑ Fauser C, Nahrig J, Niedermeyer H, Arnold W. Proliferative myositis: a rare pseudomalignant tumor of the head and neck. Archives of Otolaryngology - Head &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Neck Surgery [serial on the Internet]. (2008, Apr), [cited March 16, 2011]; 134(4): 437-440. Available from: CINAHL with Full Text.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Stanford University. Proliferative Myositis. Available at http://surgpathcriteria.stanford.edu/softfib/proliferative_myositis/printable.html. Accessed April 4, 2011
  3. ↑ 3.0 3.1 Meis J, Enzinger F. Proliferative fasciitis and myositis of childhood. The American Journal Of Surgical Pathology [serial on the Internet]. (1992, Apr), [cited March 16, 2011]; 16(4): 364-372. Available from: MEDLINE.
  4. ↑ 4.0 4.1 Dent C, DeBoom G, Hamlin M. Proliferative myositis of the head and neck. Report of a case and review of the literature. Oral Surgery, Oral Medicine, And Oral Pathology [serial on the Internet]. (1994, Sep), [cited March 16, 2011]; 78(3): 354-358. Available from: MEDLINE.
  5. ↑ 5.0 5.1 Mulier S, Stas M, Delabie J, Lateur L, Gysen M, De Wever I, et al. Proliferative myositis in a child. Skeletal Radiology [serial on the Internet]. (1999, Dec), [cited March 16, 2011]; 28(12): 703-709. Available from: MEDLINE.
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