Leiomyoma

Leiomyoma
Diagnosis in short
Lipoleiomyoma. H&E stain.
LM	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
LM DDx	leiomyosarcoma, STUMP, dermatomyofibroma, adenomatoid tumour
Gross	well-circumscribed, whorled appearance, firm
Site	skin, uterus, others
Syndromes	hereditary leiomyomatosis and renal cell cancer (cutaneous & uterine leiomyomas)
Symptoms	skin: pain, uterus: bulky
Prevalence	very common - esp. uterine
Prognosis	benign

A leiomyoma is a very common benign tumour of smooth muscle. Leiomyomas fit into the soft tissue group of lesions. They are extremely common in the uterus. They may also be seen in the skin.

General

• Benign.

Cutaneous leiomyomas

• May be part of hereditary leiomyomatosis and renal cell cancer (HLRCC).
• Painful skin lesion.

Uterine leiomyoma

Main article: Uterine leiomyoma

• Often called "fibroids".
• Extremely common... 40% of women by age 40.
• Can be a cause of AUB (abnormal uterine bleeding).
• 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.

Colonic leiomyoma

Main article: Colonic leiomyoma

Renal leiomyoma

Main article: Renal leiomyoma

Gross

• Sharply circumscribed.
• Gray-white.
• Whorled appearance.

Factors that raise concern for leiomyosarcoma:

• Haemorrhage.
• Cystic degeneration.
• Necrosis.

Microscopic

Features:

• Spindle cells arranged in fascicles.
  • 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.
• +/-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.
• Hypercellularity.
• Nuclear atypia seen at low power.
• 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.
• Dermatomyofibroma.
• 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

• Lipoleiomyoma - with adipose tissue.
• Hypercellular leiomyoma - hypercellularity assoc. with more mutations.
• Atypical leiomyoma (AKA symplastic leiomyoma) - leiomyoma with nuclear atypia.
• Benign metastasizing leiomyoma.
  • This is just what it sounds like. Some believe these are low grade leiomyosarcomas.

• 

  Atypical leiomyoma - low mag. (WC/Nephron)

• 

  Atypical leiomyoma - intermed. mag. (WC/Nephron)

• 

  Atypical leiomyoma - high mag. (WC/Nephron)

• 

  Lipoleiomyoma - low mag. (WC/Nephron)

• 

  Lipoleiomyoma - high mag. (WC/Nephron)

IHC

Work-up of suspicious leiomyomas:

• CD10 +ve.
• Ki-67 -ve.
• SMA +ve.
• Desmin +ve.

Other stains:

• H-caldesmon +ve.

Sign out

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.

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

• Leiomyosarcoma.
• Soft tissue lesions.