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Penis and scrotum
Neoplastic lesions of scrotum
Leiomyoma with bizarre nuclei
Editors: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (see Author/Reviewers page)
Revised: 22 May 2010, last major update May 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Very rare
Terminology
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● Also called symplastic, atypical or pleomorphic leiomyoma
Etiology
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● Nuclear atypia most likely is degenerative, as in ancient schwannomas
Clinical features
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● Benign with no local recurrence or distant metastases
Case reports
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● 59 year old man (Cases J 2008 Dec 9;1(1):381)
● 65 year old man (J Med Case Reports 2008 Sep 9;2:295)
● 69 year old man with 6 year history of scrotal mass (Archives 2004;128:e37)
Clinical images
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Scrotal tumor
Gross description (Macroscopy)
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● Firm, well-delineated mass, tan-yellow, solid
Micro description (Histopathology)
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● Well-circumscribed, non-encapsulated multilobulated tumor
● Fascicles of spindle cells with cigar shaped nuclei, abundant eosinophilic cytoplasm
● Varying amounts of cells with hyperchromasia, pleomorphic nuclei and macronucleoli
● No mitotic figures, no hypercellularity, no infiltrative margins, no necrosis
Micro images
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Pleomorphic nuclei with nuclear inclusions
Smooth muscle cells with focal atypia Various images
Uterine tumors
Positive stains
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● Vimentin, desmin, smooth muscle actin, muscle specific actin, H-caldesmon (Mod Pathol 1998;11:282)
Negative stains
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● Cytokeratin, neurofilament, HMB45
Differential Diagnosis
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● Angioleiomyoma: arises from vessel musculature, encapsulated, highly vascular, painful
● Leiomyosarcoma: >10 mitosis/10 HPF (although any mitotic activity in a scrotal lesion is worrisome), pleomorphism, coagulation necrosis
● Piloleiomyoma: arises from arrectores pilorum muscle of dermis, poorly delineated, painful
End of Penis and scrotum > Neoplastic lesions of scrotum > Leiomyoma with bizarre nuclei
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