Breast

Other benign tumors

Leiomyoma


Editorial Board Member: Julie M. Jorns, M.D.
Deputy Editor-in-Chief: Gary Tozbikian, M.D.
Reena Tomar, M.B.B.S., M.D.

Last author update: 18 January 2024
Last staff update: 18 January 2024

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PubMed Search: Breast leiomyoma

Reena Tomar, M.B.B.S., M.D.
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Cite this page: Tomar R. Leiomyoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/breastleiomyoma.html. Accessed March 28th, 2024.
Definition / general
Essential features
  • Benign smooth muscle tumor
  • Spindle shaped cells with cigar shaped nuclei arranged in whorls and fascicles
  • SMA, desmin, caldesmon positive
Epidemiology
Sites
Pathophysiology
Etiology
Clinical features
Diagnosis
Radiology description
Radiology images

Images hosted on other servers:
Well defined, circumscribed, hypoechoic mass

Well defined, circumscribed, hypoechoic mass

Case reports
Treatment
Clinical images

Images hosted on other servers:
1 cm nodule (black arrow) on left areola

1 cm nodule (black arrow) on left areola

Left nipple (white arrow), nodule (black arrow)

Left nipple (white arrow), nodule (black arrow)

Swollen left nipple compared with the right nipple

Swollen left nipple compared with the right nipple

Gross description
Gross images

Images hosted on other servers:

Well circumscribed skin covered mass

Frozen section description
Frozen section images

Contributed by Reena Tomar, M.B.B.S., M.D.
Scrapes

Scrapes

Scrapes (toluidine blue)

Scrapes (toluidine blue)

Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Reena Tomar, M.B.B.S., M.D., Mark R. Wick, M.D. and Julie M. Jorns, M.D.
Dermal circumscribed leiomyoma

Dermal circumscribed leiomyoma

Spindle shaped cells

Spindle shaped cells

Fascicles

Fascicles

Whorls and fascicles

Whorls and fascicles

SMA SMA

SMA


Caldesmon

Caldesmon

Desmin

Desmin

PR

PR

S100

S100

Fascicles

Fascicles


Leiomyoma - breast core biopsy Leiomyoma - breast core biopsy

Breast core biopsy

Leiomyoma - breast core biopsy Leiomyoma - breast core biopsy

Breast core biopsy

Negative stains
Sample pathology report
  • Right breast (nipple), punch biopsy:
    • Nipple leiomyoma (see comment)
    • Comment: There is a circumscribed dermal proliferation of monotonous spindle cells. On immunohistochemistry, spindle cells are positive for SMA and desmin and negative for S100 and CK, supporting the diagnosis.
Differential diagnosis
Board review style question #1

A 35 year old woman presents with a freely mobile lump in the nipple areolar area of the left breast. Microscopy shows features in image above with no mitosis or atypia. Which of the following immunohistochemical markers is best to confirm and highlight the diagnosis?

  1. CK72
  2. Ki67
  3. S100
  4. SMA
Board review style answer #1
D. SMA highlights smooth muscle origin. Answer A is incorrect because CK72 is an epithelial marker. Answer C is incorrect because S100 is a neural marker. Answer B is incorrect because Ki67 is a proliferation marker that will be low in benign leiomyoma but will not help in diagnosis.

Comment Here

Reference: Leiomyoma
Board review style question #2

Which of the following is typically true about breast leiomyoma?

  1. Has nipple discharge
  2. Has no hormonal association
  3. Is imaging occult
  4. May be painful
Board review style answer #2
D. May be painful. Nipple adenomas may be painful, which may be alleviated by calcium channel or alpha adrenergic blockers that cause smooth muscle relaxation. Answer C is incorrect because breast leiomyoma may be seen as a mass on breast imaging modalities such as mammogram and ultrasound. Answer B is incorrect because breast leiomyomas are associated with hormonal agents. Answer A is incorrect because breast leiomyoma has not been associated with nipple discharge.

Comment Here

Reference: Leiomyoma
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