Indian Journal of Dermatology
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E-IJD-CASE REPORT
Year : 2014  |  Volume : 59  |  Issue : 6  |  Page : 634
Unusual presentation of cutaneous leiomyoma


1 Department of Dermatology, Vydehi Institute of Medical Sciences and Research Hospital, Whitefield, Bangalore, India
2 Department of Pathology, Vydehi Institute of Medical Sciences and Research Hospital, Whitefield, Bangalore, India

Date of Web Publication30-Oct-2014

Correspondence Address:
Ashok K Jaiswal
Department of Dermatology, Vydehi Institute of Medical Sciences and Research Hospital, Whitefi eld, Bangalore - 560 066
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.143590

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   Abstract 

Herein, we report a case of leiomyoma cutis because of its rarity and unusual presentation. The case presented with a solitary leiomyoma lesion which was painless. However, the adjacent normal appearing area was tender. A biopsy of the lesion as well as of a portion of the adjacent normal appearing area was taken, which confirmed the diagnosis of cutaneous leiomyoma. This may suggest the dormant nature of the disease which has not yet become apparent.


Keywords: Leiomyoma cutis, painless, unusual presentation


How to cite this article:
Bhaskar S, Jaiswal AK, Madhu S M, Santosh K V. Unusual presentation of cutaneous leiomyoma. Indian J Dermatol 2014;59:634

How to cite this URL:
Bhaskar S, Jaiswal AK, Madhu S M, Santosh K V. Unusual presentation of cutaneous leiomyoma. Indian J Dermatol [serial online] 2014 [cited 2019 Jul 15];59:634. Available from: http://www.e-ijd.org/text.asp?2014/59/6/634/143590

What was known?
Leiomyomas are painful smooth muscle tumors.



   Introduction Top


Leiomyomas are benign painful soft-tissue neoplasms that stem from the erector pili muscle, the muscular layer of blood vessels, and the tunica dartos, labia majora, or nipple. There are three types: (a) Piloleiomyoma (cutaneous leiomyomas, leiomyoma cutis); (b) dartoic leiomyoma; and (c) angioleiomyoma. [1] Cutaneous leiomyomas comprise about 5% of all leiomyomas. [2] This report is to highlight an unusual presentation of leiomyoma cutis.


   Case Report Top


A 55-year-old male patient presented with a 4 year history of solitary painless swelling over the anterior abdominal wall. To start with the lesion was small in size, which gradually increased to attain the present size of about 5 mm. A year later he noticed pain adjacent to the nodule which aggravated on pressure. There was no family history.

Cutaneous examination revealed a single firm skin colored nodule over the abdomen just above the umbilical area [Figure 1]. On palpation, the nodule was non-tender, however, the area adjacent to the lesion was tender. Histopathology of the lesion as well as of a portion of the adjacent normal appearing skin was done, which showed short fascicles and whorls of spindled smooth muscle cells in the dermis which confirmed the diagnosis of cutaneous leiomyoma. The diagnosis was further confirmed by using Masson's Trichome stain (MTS) which stained the smooth muscles pink [Figure 2].
Figure 1: Single skin colored nodule over the anterior abdominal wall

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Figure 2: Dermis depicts a circumscribed spindle cell tumor with cells oriented in short fascicles. The spindle cells are stained pink and the adjacent collagen blue (MTS), original magnifi cation × 10

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   Discussion Top


Leiomyoma cutis are relatively uncommon benign tumors of smooth muscle derived from the arrector pili muscle. They may present as solitary as well as multiple lesions. [3] Most leiomyomas are sporadic, but it has been suggested that multiple leiomyomas may be inherited as an autosomal dominant trait. [4] Patients with piloleiomyomas often have pain that may be spontaneous or secondary to cold, pressure, or emotion. [5] The pathogenesis of pain associated with these lesions is unresolved. Some reports suggest that pain could result from local pressure by tumor on cutaneous nerves, whereas others have hypothesized that muscle contraction may be central to induction of pain. [6]

Interesting fact in our case was the patient presented with a solitary leiomyoma lesion which was painless. However, the adjacent normal looking skin was tender. Though the leiomyoma lesion may at times be painless, the reason as to why the adjacent area was tender is not understood, probably suggesting the dormant nature of the disease which has not yet become apparent and may progress to develop into a classical leiomyoma lesion later on. Further studies may be required to substantiate our conclusion.

 
   References Top

1.Calonje E. Soft tissue tumours and tumour-like conditions. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook Textbook of Dermatology. 8 th ed. UK:Wiley-Blackwell, 2010; p. 56.54-55.  Back to cited text no. 1
    
2.Spencer JM, Amonette RA. Tumors with smooth muscle differentiation. Dermatol Surg 1996;22:761-8.  Back to cited text no. 2
    
3.Muscle KS. Adipose and cartilage neoplasia. In: Bolognia JL, Jorizzo JL, Rapini RP, editors. Bolognia: Dermatology. 2 nd ed. USA: Mosby Elsevier; 2008; p. 1831-3.  Back to cited text no. 3
    
4.Dermal and subcutaneous tumors. In: Arnold HL, Odom RB, James WD, editors. Andrew's Diseases of the Skin - Clinical Dermatology. 8 th ed. Philadelphia: WB Saunders Company, 1990; p. 738-9.  Back to cited text no. 4
    
5.Holst VA, Junkins-Hopkins JM, Elenitsas R. Cutaneous smooth muscle neoplasms: Clinical features, histologic findings, and treatment options. J Am Acad Dermatol 2002;46:477-90.  Back to cited text no. 5
    
6.Raj S, Calonje E, Kraus M, Kavanagh G, Newman PL, Fletcher CD. Cutaneous pilar leiomyoma: Clinicopathologic analysis of 53 lesions in 45 patients. Am J Dermatopathol 1997;19:2-9.  Back to cited text no. 6
    

What is new?
Painless leiomyoma tumor with adjacent tender area probably showing the dormant nature of the disease.


    Figures

  [Figure 1], [Figure 2]



 

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