Soft tissue tumors - Bizarre leiomyoma

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Soft tissue tumors

Smooth muscle

Bizarre leiomyoma

Reviewer: Vijay Shankar, M.D. (see Reviewers page)
Revised: 23 February 2013, last major update November 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

Leiomyoma: see also classic, bizarre, cutaneous>, epithelioid, genital, leiomyoma of deep soft tissue

Terminology
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● Also called symplastic, atypical, apoplectic leiomyoma

Epidemiology
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● Usually found in uterus; also scrotum, skin (Am J Dermatopathol 2001;23:299)

Clinical features
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● May recur locally after excision (Ann Diagn Pathol 2008;12:328)

Case reports
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● 59 year old man with scrotal mass (Cases J 2008;1:381)
● 68 year old woman with thigh nodule (Dermatol Online J 2009;15:6)
● 69 year old man with scrotal mass (Arch Pathol Lab Med 2004;128:e37)
● 72 year old woman with nasal cavity mass (J Clin Pathol 2002;55:872)

Clinical images
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Scrotal mass

Thigh nodule

Micro description
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● Large, atypical nuclei in otherwise normal appearing leiomyoma
● No/rare mitotic figures
● Suggested classification for vulvar tumors is based on number of features below (0-1: leiomyoma, 2: atypical leiomyoma, 3-4: leiomyosarcoma)
(a) 5+ cm in greatest dimension
(b) infiltrative margins
(c) 5+ mitotic figures per 10 HPF
(d) moderate to severe cytologic atypia (Am J Surg Pathol 1996;20:779)

Micro images
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Smooth muscle cells with focal atypia

68 year old woman with thigh nodule (figures 2-5)

72 year old woman with nasal obstruction, rhinorrea, and epistaxis

Positive stains
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● Desmin, smooth muscle actin, muscle specific actin, vimentin (Mod Pathol 1998;11:282)

Negative stains
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● Keratin, GFAP

End of Soft tissue tumors > Smooth muscle > Bizarre leiomyoma

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