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A '''leiomyoma''' is a very common benign 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]]. | {{ 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]]. | |||
==General== | ==General== | ||
*Benign. | *Benign. | ||
===Uterine | ===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> | |||
*[[Painful skin lesion]]. | |||
===Uterine leiomyoma=== | |||
{{Main|Uterine leiomyoma}} | |||
*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== | ||
| Line 25: | Line 68: | ||
** 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. | ||
* +/-Medium-sized artery seen at the periphery of the lesion. | |||
** Often arise from a muscular artery. | |||
Uncommonly present - see note: | |||
* Necrosis (low power) - suggestive of leiomyosarcoma. | * Necrosis (low power) - suggestive of leiomyosarcoma. | ||
* Hypercellularity. | * Hypercellularity. | ||
* Nuclear atypia seen at low power. | * Nuclear atypia seen at low power. | ||
* Few mitoses. | * Few mitoses. | ||
Note: | |||
*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: | |||
*[[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> | |||
*[[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=== | ||
*Lipoleiomyoma - with adipose tissue. | *Lipoleiomyoma - with adipose tissue. | ||
*Hypercellular leiomyoma - hypercellularity assoc. with more mutations.<ref>[http://www3.interscience.wiley.com/journal/119360394/abstract http://www3.interscience.wiley.com/journal/119360394/abstract]</ref> | *Hypercellular leiomyoma - hypercellularity assoc. with more mutations.<ref>[http://www3.interscience.wiley.com/journal/119360394/abstract http://www3.interscience.wiley.com/journal/119360394/abstract]</ref> | ||
*Atypical leiomyoma (AKA ''symplastic leiomyoma'') - leiomyoma with nuclear atypia | *Atypical leiomyoma ([[AKA]] ''symplastic leiomyoma'') - leiomyoma with nuclear atypia. | ||
*Benign metastasizing leiomyoma.<ref>{{Cite journal | last1 = Patton | first1 = KT. | last2 = Cheng | first2 = L. | last3 = Papavero | first3 = V. | last4 = Blum | first4 = MG. | last5 = Yeldandi | first5 = AV. | last6 = Adley | first6 = BP. | last7 = Luan | first7 = C. | last8 = Diaz | first8 = LK. | last9 = Hui | first9 = P. | title = Benign metastasizing leiomyoma: clonality, telomere length and clinicopathologic analysis. | journal = Mod Pathol | volume = 19 | issue = 1 | pages = 130-40 | month = Jan | year = 2006 | doi = 10.1038/modpathol.3800504 | PMID = 16357844 |url=http://www.nature.com/modpathol/journal/v19/n1/full/3800504a.html}}</ref> | *Benign metastasizing leiomyoma.<ref>{{Cite journal | last1 = Patton | first1 = KT. | last2 = Cheng | first2 = L. | last3 = Papavero | first3 = V. | last4 = Blum | first4 = MG. | last5 = Yeldandi | first5 = AV. | last6 = Adley | first6 = BP. | last7 = Luan | first7 = C. | last8 = Diaz | first8 = LK. | last9 = Hui | first9 = P. | title = Benign metastasizing leiomyoma: clonality, telomere length and clinicopathologic analysis. | journal = Mod Pathol | volume = 19 | issue = 1 | pages = 130-40 | month = Jan | year = 2006 | doi = 10.1038/modpathol.3800504 | PMID = 16357844 |url=http://www.nature.com/modpathol/journal/v19/n1/full/3800504a.html}}</ref> | ||
**This is just what it sounds like. Some believe these are low grade [[leiomyosarcoma]]s | **This is just what it sounds like. Some believe these are low grade [[leiomyosarcoma]]s. | ||
<gallery> | |||
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:Lipoleiomyoma2.jpg | Lipoleiomyoma - high mag. (WC/Nephron) | |||
</gallery> | |||
==IHC== | ==IHC== | ||
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*SMA +ve. | *SMA +ve. | ||
*Desmin +ve. | *Desmin +ve. | ||
Other stains: | |||
*H-caldesmon +ve.<ref name=pmid21887931>{{Cite journal | last1 = Zámecník | first1 = M. | last2 = Kascák | first2 = P. | title = Uterine leiomyoma with amianthoid-like fibers. | journal = Cesk Patol | volume = 47 | issue = 3 | pages = 125-7 | month = Jul | year = 2011 | doi = | PMID = 21887931 }}</ref> | |||
==Sign out== | |||
<pre> | |||
SKIN LESION, RIGHT LEG, EXCISION: | |||
- LEIOMYOMA. | |||
- NEGATIVE FOR MALIGNANCY. | |||
COMMENT: | |||
The lesion stains for desmin and SMA. It is negative for S-100 and has minimal staining with Ki-67. | |||
</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== | ||
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[[Category:Soft tissue lesions]] | [[Category:Soft tissue lesions]] | ||
[[Category:Diagnosis]] | |||