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Soft Tissue Tumors Part 3

Muscle, Vascular, Nerve, Other

Leiomyoma-Classic

 

Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.

Revised: 9 August 2009, last major update - August 2009

Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.

 

Leiomyoma: classic, bizarre, cutaneous, epithelioid, genital

See also: leiomyoma of deep soft tissue

 

Definition

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● Bland smooth muscle tumor without mitotic figures

 

Terminology

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● Not a WHO diagnosis (cutaneous and pilar tumors are described in the Skin volume)

● Some tumors previously considered to be leiomyomas are actually GI stromal (GIST) tumors

● See also Colon-tumor, Esophagus, Uterus chapters

 

Epidemiology

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● Skin and subcutis; also deep soft tissue, uterus (most common neoplasm in women)

● Patients with multiple cutaneous leiomyomas may have autosomal dominant disorder (described under Cutaneous leiomyoma)

 

Case reports

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● 34 year old man with sickle cell thalassemia and ossified leiomyoma (J Cutan Pathol 2005;32:696)

● 59 year old woman with finger lesion (Chang Gung Med J 2004;27:134)

 

Gross images

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Images: myxoid subcutaneous tumor

 

Micro description

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● Bundles or fascicles of spindled cells with eosinophilic and possibly fibrillary cytoplasm

● Nuclei are blunt ended and elongated with fine chromatin, indistinct nucleolus and variable cytoplasmic vacuole at one end

● Minimal atypia

● Few mitotic figures

● No coagulative tumor necrosis

 

Micro images

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Bundles of elongate cells                 Oblong nuclei

with eosinophilic cytoplasm            have rounded ends

and oblong nuclei

 

Other images: calcified leiomyoma #1#2#3#4

 

Positive stains

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● Desmin, alpha smooth muscle actin

● h-caldesmon, calponin, muscle specific actin, myosin

● ER and PR for uterine tumors

 

Negative stains

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● CD117, CD34, S100; low Ki-67 (<5%)

 

Differential diagnosis

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● Angiomyolipoma - usually prominent vascular and lipomatous component

● Leiomyosarcoma - more cellular, infiltrative, pleomorphic; mitotic activity and coagulative tumor cell necrosis

 

References

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eMedicine

 

End of Soft Tissue Tumors Part 3 - Muscle, Vascular, Nerve, Other > Classic leiomyoma

 

 

 

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