Difference between revisions of "Leiomyoma"

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Leiomyoma (view source)

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Lipoleiomyoma2.jpg
| Width      =
| Caption    = Lipoleiomyoma. [[H&E stain]].
| Micro      = spindle cells arranged in fascicles, +/-nuclear atypia, rare mitoses (allowable mitotic rate dependent on specific site)
| Subtypes  = lipoleiomyoma, hypercellular leiomyoma, atypical leiomyoma (symplastic leiomyoma), benign metastasizing leiomyoma
| LMDDx      = [[leiomyosarcoma]], [[STUMP]], [[dermatomyofibroma]], [[adenomatoid tumour]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = well-circumscribed, whorled appearance, firm
| Grossing  =
| Site      = [[skin]], [[uterus]], others
| Assdx      =
| Syndromes  = [[hereditary leiomyomatosis and renal cell cancer]] (cutaneous & uterine leiomyomas)
| Clinicalhx =
| Signs      =
| Symptoms  = skin: [[painful skin lesion|pain]], uterus: bulky
| Prevalence = very common - esp. uterine
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    =
}}
A '''leiomyoma''' is a very common benign [[smooth muscle tumours|tumour of smooth muscle]].  Leiomyomas fit into the ''[[soft tissue lesions|soft tissue]]'' group of lesions.  They are extremely common in the [[uterus]].  They may also be seen in the [[skin]].
A '''leiomyoma''' is a very common benign [[smooth muscle tumours|tumour of smooth muscle]].  Leiomyomas fit into the ''[[soft tissue lesions|soft tissue]]'' group of lesions.  They are extremely common in the [[uterus]].  They may also be seen in the [[skin]].


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===Cutaneous leiomyomas===
===Cutaneous leiomyomas===
*May be part of ''Hereditary Leiomyomatosis and Renal Cell Cancer'' (HLRCC).<ref>URL: [http://www.ncbi.nlm.nih.gov/books/NBK1252/ http://www.ncbi.nlm.nih.gov/books/NBK1252/]. Accessed on: 2 September 2011.</ref><ref>URL: [http://ccr.cancer.gov/staff/gallery.asp?profileid=12822 http://ccr.cancer.gov/staff/gallery.asp?profileid=12822]. Accessed on: 2 September 2011.</ref>
*May be part of ''[[hereditary leiomyomatosis and renal cell cancer]]'' (HLRCC).<ref>URL: [http://www.ncbi.nlm.nih.gov/books/NBK1252/ http://www.ncbi.nlm.nih.gov/books/NBK1252/]. Accessed on: 2 September 2011.</ref><ref>URL: [http://ccr.cancer.gov/staff/gallery.asp?profileid=12822 http://ccr.cancer.gov/staff/gallery.asp?profileid=12822]. Accessed on: 2 September 2011.</ref>
*[[Painful skin lesion]].


===Uterine leiomyoma===
===Uterine leiomyoma===
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*Often called "fibroids".
*Often called "fibroids".
*Extremely common... 40% of women by age 40.
*Extremely common... 40% of women by age 40.
*Can be a cause of [[AUB]] (abnormal uterine bleeding).
*Can be a cause of [[AUB]] ([[abnormal uterine bleeding]]).
*Large & multiple leiomyomas are associated with infertility.
*Large & multiple leiomyomas are associated with infertility.
*May be part of ''[[hereditary leiomyomatosis and renal cell cancer]]'' (HLRCC).
**In one series, 68% with HLRCC were diagnosed at age <=30 years.<ref name=pmid16597677>{{Cite journal  | last1 = Pithukpakorn | first1 = M. | last2 = Wei | first2 = MH. | last3 = Toure | first3 = O. | last4 = Steinbach | first4 = PJ. | last5 = Glenn | first5 = GM. | last6 = Zbar | first6 = B. | last7 = Linehan | first7 = WM. | last8 = Toro | first8 = JR. | title = Fumarate hydratase enzyme activity in lymphoblastoid cells and fibroblasts of individuals in families with hereditary leiomyomatosis and renal cell cancer. | journal = J Med Genet | volume = 43 | issue = 9 | pages = 755-62 | month = Sep | year = 2006 | doi = 10.1136/jmg.2006.041087 | PMID = 16597677 }}
</ref>
===Colonic leiomyoma===
{{Main|Colonic leiomyoma}}
===Renal leiomyoma===
{{Main|Renal leiomyoma}}


==Gross==
==Gross==
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** Fascicular appearance: adjacent groups of cells have their long axis perpendicular to one another; looks somewhat like a braided hair that was cut.
** Fascicular appearance: adjacent groups of cells have their long axis perpendicular to one another; looks somewhat like a braided hair that was cut.
* Whorled arrangement of cells.
* Whorled arrangement of cells.
* Often arise from a muscular artery -- medium-sized artery seen at the periphery of the lesion.
* +/-Medium-sized artery seen at the periphery of the lesion.
** Often arise from a muscular artery.


Uncommonly present - see note:
Uncommonly present - see note:
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Note:
Note:
*Leiomyosarcoma is diagnosed if all of the following are present: (1) high mitotic rate (dependent on site), (2) marked nuclear atypia (seen at low power), (3) [[necrosis]].
*Leiomyosarcoma is diagnosed if 2 of 3 are present: (1) high mitotic rate (dependent on site), (2) marked nuclear atypia (seen at low power), (3) [[necrosis]].


DDx:
DDx:
*[[Leiomyosarcoma]].
*[[Leiomyosarcoma]].
**Lipoleiomyosarcoma - very rare.<ref name=pmid12023578>{{Cite journal  | last1 = Folpe | first1 = AL. | last2 = Weiss | first2 = SW. | title = Lipoleiomyosarcoma (well-differentiated liposarcoma with leiomyosarcomatous differentiation): a clinicopathologic study of nine cases including one with dedifferentiation. | journal = Am J Surg Pathol | volume = 26 | issue = 6 | pages = 742-9 | month = Jun | year = 2002 | doi =  | PMID = 12023578 }}</ref>
*Dermatomyofibroma.<ref name=Ref_Derm533>{{Ref Derm|533}}</ref>
*Dermatomyofibroma.<ref name=Ref_Derm533>{{Ref Derm|533}}</ref>
*[[Myopericytoma]] / [[myofibroma]].
*[[Myopericytoma]] / [[myofibroma]].
*[[Adenomatoid tumour]] - esp. for lipoleiomyoma.
*[[Smooth muscle tumour of uncertain malignant potential]] (STUMP) - do not fulfill criteria for leiomyosarcoma.
*[[Epstein-Barr virus-associated smooth muscle tumour]] - very rare.


===Variants===
===Variants===
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<gallery>
<gallery>
Image:Atypical_leiomyoma_intermed_mag.jpg | Atypical leiomyoma. (WC/Nephron)
Image:Atypical_leiomyoma_low_mag.jpg | Atypical leiomyoma - low mag. (WC/Nephron)
Image:Atypical_leiomyoma_intermed_mag.jpg | Atypical leiomyoma - intermed. mag. (WC/Nephron)
Image:Atypical_leiomyoma_high_mag.jpg | Atypical leiomyoma - high mag. (WC/Nephron)
Image:Lipoleiomyoma1.jpg | Lipoleiomyoma - low mag. (WC/Nephron)
Image:Lipoleiomyoma1.jpg | Lipoleiomyoma - low mag. (WC/Nephron)
Image:Lipoleiomyoma2.jpg | Lipoleiomyoma - high mag. (WC/Nephron)
</gallery>
</gallery>


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The lesion stains for desmin and SMA. It is negative for S-100 and has minimal staining with Ki-67.
The lesion stains for desmin and SMA. It is negative for S-100 and has minimal staining with Ki-67.
</pre>
</pre>
===Micro===
The section shows unremarkable hair-bearing skin with a well-circumscribed subcutaneous lesion with a fascicular architecture.  The lesion has no nuclear atypia and no mitotic activity is identified.  At the periphery of the lesion is a medium-sized muscular artery from which the lesion appears to arise.
====Alternate====
The sections show a spindle cell lesion with a fascicular architecture. Focal hyaline
change is seen. No nuclear atypia is apparent.  Mitotic activity is not readily identified. No necrosis is identified. The lesion extends to the edge of the tissue fragments.


==See also==
==See also==
Michael
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