11 February 2009 - Case #138
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This case was contributed by Dr. Julia Braza, Beth Israel Deaconess Medical Center, Boston, Massachusetts (USA).
Case #138
Clinical history:
A 51 year old man with bilateral chronic sinusitis had a left inferior turbinate mass, which was excised. Grossly, there was a small, round, fleshy white nodule up to 0.6 cm.
Microscopic images:
What is your diagnosis?
Diagnosis: Angioleiomyoma (vascular leiomyoma)
Immunostains:
Discussion:
Vascular leiomyoma (angioleiomyoma) is a benign tumor of smooth muscle and endothelium, that is rare in the head and neck and very rare in the nasal cavity (J Laryngol Otol 1994;108:244). Most cases in the head and neck occur in women (B-ENT 2008;4:105). Although one tumor was PR+, suggesting that the tumor is hormone dependent, other reports have found no ER or PR expression (Acta Otolaryngol 2002;122:408, Chin Med J (Engl) 2007;120:350).
The tumor is composed of spindle cells that resemble smooth muscle. Higher magnification shows numerous vessels composed of glomus type cells. The tumor cells were positive for smooth muscle actin and focally positive for desmin. The negative staining for desmin in some cells suggests a focal glomus type differentiation. Some authors subclassify these tumors as capillary, cavernous or venous but this appears to have no clinical significance.
Treatment is simple excision (Laryngoscope 2004;114:661).
All cases are archived on our website. To view them sorted by case number, diagnosis or category, visit our main Case of the Month page. To subscribe or unsubscribe to Case of the Month or our other email lists, click here.
This case was contributed by Dr. Julia Braza, Beth Israel Deaconess Medical Center, Boston, Massachusetts (USA).
Case #138
Clinical history:
A 51 year old man with bilateral chronic sinusitis had a left inferior turbinate mass, which was excised. Grossly, there was a small, round, fleshy white nodule up to 0.6 cm.
Microscopic images:
What is your diagnosis?
Click here for diagnosis and discussion:
Diagnosis: Angioleiomyoma (vascular leiomyoma)
Immunostains:
Desmin
Smooth muscle actin
Discussion:
Vascular leiomyoma (angioleiomyoma) is a benign tumor of smooth muscle and endothelium, that is rare in the head and neck and very rare in the nasal cavity (J Laryngol Otol 1994;108:244). Most cases in the head and neck occur in women (B-ENT 2008;4:105). Although one tumor was PR+, suggesting that the tumor is hormone dependent, other reports have found no ER or PR expression (Acta Otolaryngol 2002;122:408, Chin Med J (Engl) 2007;120:350).
The tumor is composed of spindle cells that resemble smooth muscle. Higher magnification shows numerous vessels composed of glomus type cells. The tumor cells were positive for smooth muscle actin and focally positive for desmin. The negative staining for desmin in some cells suggests a focal glomus type differentiation. Some authors subclassify these tumors as capillary, cavernous or venous but this appears to have no clinical significance.
Treatment is simple excision (Laryngoscope 2004;114:661).
