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Penis and scrotum
Other malignancies
Leiomyosarcoma
Editor: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (see Author/Reviewers page)
Revised: 16 May 2010, last major update May 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Malignant tumor similar to their counterparts elsewhere in the body
● ICD-O: 8890/3
Epidemiology
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● Mean age 51 years, range 43-62 years
● Very rare, <50 cases reported, but still second most common sarcoma of penis after Kaposi’s sarcoma
Sites
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● Usually shaft or base of penis but can occur at any site
Clinical features
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● More likely to be superficial (above tunica albuginea) than deep-seated
● Often recurs locally
● Superficial lesions are asymptomatic, deep seated lesions may cause dysuria or difficulty voiding
Prognostic factors
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● Favorable factors are tumor depth of 2 cm or less and tumor size of 5 cm or less (Am J Surg Pathol 2004;28:115)
Case reports
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● 56 year old man with deep seated tumor (Indian J Pathol Microbiol 2009;52:447)
Treatment
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● Wide local excision if superficial, excision as necessary for complete removal of deeper tumors
Gross description (Macroscopy)
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● Median 1.5 cm (range 0.5 to 6.0 cm), often superficial
● White-tan-gray, firm tumor with irregular borders
Micro description (Histopathology)
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● Interlacing fascicles of spindle cells with abundant eosinophilic cytoplasm, focal juxtanuclear vacuoles and blunt-ended nuclei
● Atypia ranges from moderate to severe
● Occasionally atypical multinucleated giant cells, focal necrosis
● Mitoses easily found and can be numerous
Micro images
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Smooth muscle actin
Positive stains
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● Desmin, muscle-specific actin, alpha-smooth muscle actin
Differential Diagnosis
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● Kaposi’s sarcoma (nodular): superficial location, slit-like vascular spaces with numerous erythrocytes, no atypia, positive for HHV-8, CD31, CD34, Factor VIII
● Leiomyoma: exceedingly rare, similar to other leiomyomas elsewhere, no/rare mitotic figures, no atypia, no necrosis
● Myointimoma: more plexiform pattern of growth, no nuclear atypia, minimal reactivity for desmin
● Melanoma with storiform growth: typical melanoma elsewhere, positive for melanocytic markers (HMB-45, MelanA)
● Sarcomatoid carcinoma: squamous epithelial nests within tumor mass, associated areas of PeIN, positivity for pan-keratin, keratin 34-beta-E12 and p63, negativity for muscle markers
End of Penis and scrotum > Other malignancies > Leiomyosarcoma
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