Disseminated cutaneous myxomas in an adult

New York, NY 10029 A 45-year-old Hispanic man presented with a 4-year history of progressively increasing numbers of skin-colored, nonpruritic papules on the trunk. His past medical history was significant only for hypertension. The patient had no systemic symptoms, and he had no family history of such lesions. Physical examination revealed approximately 100 round, dome-shaped, soft white to skin-colored papules scattered predominantly over the back, chest (Fig. 1), and abdomen; several papules were present on the lower extremities. There was no evidence of mucosal myxomas or mucocutaneous lentigines, ephelides, or nevi. The patient's physical appearance was normal, without evidence of Cushing's syndrome, excessive growth hormone, or any other endocrinopathies. Figure 1Open in figure viewerPowerPoint Multiple cutaneous myxomas on the left chest Laboratory investigation included the following: an echocardiogram was negative for cardiac myxomas; a chest X-ray was negative; and a stool guaiac was negative for blood. Serum protein electrophoresis was negative for paraproteinemia, and the levels of growth hormone, cortisol, and free testosterone were within normal limits. Baseline complete blood count (CBC), chemistry panel, thyroid function studies, erythrocyte sedimentation rate (ESR), antinuclear antibody, and urinalysis were unremarkable. A skin biopsy specimen revealed a large amount of amorphous bluish material separating collagen bundles within the upper and mid-dermis (2, 3). Within this material, there were some small spindle-shaped and polygonal cells. An alcian blue stain demonstrated the abundance of dermal mucin. The diagnosis was compatible with cutaneous myxoma. Figure 2Open in figure viewerPowerPoint Photomicrograph showing a large amount of amorphous material in the dermis (hematoxylin and eosin, ×400) Figure 3Open in figure viewerPowerPoint At higher magnification, small spindle-shaped and polygonal cells are seen in a mucinous stroma (hematoxylin and eosin ×40) After 3 years of clinical follow-up, the patient has developed no other cutaneous lesions or systemic symptoms. The patient has refused further laboratory studies and echocardiography.