Soft tissue tumors - Cutaneous leiomyoma

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Soft tissue tumors

Smooth muscle

Cutaneous 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

Definition
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● Arises from arrector pili muscles
● Superficial, small, multiple, painful

Terminology
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● Also called cutaneous piloleiomyoma

Clinical features
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● May be due to hereditary leiomyomatosis and renal cell cancer syndrome (J Urol 2007;177:2074); may be associated with germline mutations in the fumarate hydratase gene (Nat Genet 2002;30:406, Cancer Genet Cytogenet 2008;183:83)

Case reports
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● 51 year old woman with multiple cutaneous and uterine leiomyomatosis (Dermatol Online J 2005;11:21)
● 79 year old man with hereditary leiomyomatosis and renal cell carcinoma syndrome (Dermatol Online J 2008;14:16)

Treatment
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● Avoidance of cold
● Possibly nifedipine, nitroglycerine, phenoxybenzamine (block smooth muscle contraction, Dermatol Online J 2005;11:21)
● Possibly botulinum toxin-type A (Dermatology 2009;218:44)
● Possibly excision with dermal skin template for multiple tumors (J Cutan Med Surg 2009;13:102), carbon dioxide laser ablation

Clinical images
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Leg

Shoulder

Trunk

Micro images
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Various images

51 year old woman with painful papules of the shoulder

79 year old man with multiple nodular skin lesions of leg:

Intradermal nodular neoplasm with proliferated cellular elements having elongated blunt-end nuclei and fibrillar cytoplasm

Interlacing bundles with whorled appearance of uniform neoplastic cells

Uniform neoplastic cells with no mitotic figures

Trichrome staining showed proliferative smooth muscle cells (red) with collagen (blue)

Molecular description
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● Almost all patients with multiple skin leiomyomas have germline fumarate hydratase mutation (Arch Dermatol 2005;141:199)

End of Soft tissue tumors > Smooth muscle > Cutaneous leiomyoma

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