Cutaneous leiomyomas: a clinicpathological and epidemiological review
DOI:
https://doi.org/10.23938/ASSN.0914Keywords:
Leiomyoma, Angioleiomyoma, Piloleiomyoma, Nipple leiomyoma, Breast cancerAbstract
Background. Cutaneous, superficial and or suprafascial leiomyoma are divided into three variants: piloleiomyomas (PL), angioleiomyomas (AL) and genital leiomyomas (GL) that include the vulvar, scrotal and areolar forms. This study set out to establish the clinical and histological characteristics and incidence of each variant, and any likely associations with internal neoplasms.
Methods. A review was carried out of 255 cases of cutaneous leiomyomas diagnosed between 1982 and 2018 at the Pathology departments of three hospitals (Navarra and Alicante). Demographic, clinical, histological and immunohistochemical variables were described and compared.
Results. The incidence of PL in Navarra was 4.3 cases per million inhabitants a year, with another 20 cases of AL and 1.4 cases of GL. Cutaneous forms make up approximately 3.5% of the total leiomyomas. The population with PL suffered more frequently from breast cancer (OR = 4.8; CI 95%: 1.3-17.4; p = 0.006). Nipple leiomyomas are small, accompanied by localised pain, and are predominantly fascicular or solid, with very infrequent effect on the subcutaneous cellular tissue and scarce atypia. This makes for a contrast with the other GLs, which are medium sized and infrequently painful, predominantly nodular, and frequent effect on the subcutaneous tissue and atypia.
Conclusions. The information provided here about the clinical and histological characteristics of the different varieties of leiomyomas indicate that there is a need to reconsider the classification of nipple leiomyomas outside the group of GLs. An association between PL and breast carcinoma was detected, which needs to be confirmed in future studies so as to determine if this leiomyoma is a risk marker for breast cancer.
Downloads
References
HAMMER P, WHITE K, MENGDEN S 1, KORCHEVA V, RAESS PW. Nipple leiomyoma: a rare neoplasm with a broad spectrum of histologic appearances. J Cutan Pathol 2019; 46: 343-346. https://doi.org/10.1111/cup.13423
GOKDEMIR G, SAKIZ D, KOSLU A. Multiple cutaneous leiomyomas of the nipple. J Eur Acad Dermatol Venereol 2006; 20: 468-469. https://doi.org/10.1111/j.1468-3083.2006.01451.x
RAMOS RODRIGUEZ AJ, GUO R, BRIDGES AG. Estrogen and progesterone receptor-positive bilateral nipple leiomyoma in a man. Int J Dermatol 2017; 56: 1512-1513. https://doi.org/10.1111/ijd.13662
MATOSO A, CHEN S, PLAZA JA, OSUNKOYA AO, EPSTEIN JI. Symplastic leiomyomas of the scrotum: a comparative study to usual leiomyomas and leiomyosarcomas. Am J Surg Pathol 2014; 38: 1410-1417. https://doi.org/10.1097/pas.0000000000000228
NIELSEN GP, ROSENBERG AE, KOERNER FC, YOUNG RH, SCULLY RE. Smooth-muscle tumors of the vulva. A clinicopathological study of 25 cases and review of the literature. Am J Surg Pathol 1996; 20: 779-793. https://doi.org/10.1097/00000478-199607000-00001
JANSSEN LH. Leiomyomata cutis. Acta Derm Venereol 1952; 32: 40-50.
RAJ S, CALONJE E, KRAUS M, KAVANAGH G, NEWMAN PL, FLETCHER CD. Cutaneous pilar leiomyoma: clinicopathologic analysis of 53 lesions in 45 patients. Am J Dermatopathol 1997; 19: 2-9. https://doi.org/10.1097/00000372-199702000-00002
MALHOTRA P, WALIA H, SINGH A, RAMESH V. Leiomyoma cutis: a clinicopathological series of 37 cases. Indian J Dermatol 2010; 55: 337-341. https://doi.org/10.4103/0019-5154.74535
GHANADAN A, ABBASI A, KAMYAB HESARI K. Cutaneous leiomyoma: novel histologic findings for classification and diagnosis. Acta Med Iran 2013; 51: 19-24.
ALAM NA, BARCLAY E, ROWAN AJ, TYRER JP, CALONJE E, MANEK S et al. Clinical features of multiple cutaneous and uterine leiomyomatosis: an underdiagnosed tumor syndrome. Arch Dermatol 2005; 141: 199-206. https://doi.org/10.1001/archderm.141.2.199
NEWMAN PL, FLETCHER CD. Smooth muscle tumours of the external genitalia: clinicopathological analysis of a series. Histopathology 1991; 18: 523-529. https://doi.org/10.1111/j.1365-2559.1991.tb01479.x
TAVASSOLI FA, NORRIS HJ. Smooth muscle tumors of the vulva. Obstet Gynecol 1979; 53: 213-217.
MALIK K, PATEL P, CHEN J, KHACHEMOUNE A. Leiomyoma cutis: a focused review on presentation, management, and association with malignancy. Am J Clin Dermatol 2015; 16: 35-46. https://doi.org/10.1007/s40257-015-0112-1
HACHISUGA T, HASHIMOTO H, ENJOJI M. Angioleiomyoma. A clinicopathologic reappraisal of 562 cases. Cancer 1984; 54: 126-130. https://doi.org/10.1002/1097-0142(19840701)54:1<126::aid-cncr2820540125>3.0.co;2-f
MONTGOMERY H, WINKELMANN RK. Smooth-muscle tumors of the skin. AMA Arch Derm 1959; 79: 32-40. https://doi.org/10.1001/archderm.1959.01560130034004
FISHER WC, HELWIG EB. Leiomyomas of the Skin. Arch Dermatol 1963; 88: 510-520. https://doi.org/10.1001/archderm.1963.01590230018002
HOLST VA, JUNKINS-HOPKINS JM, ELENITSAS R. Cutaneous smooth muscle neoplasms: clinical features, histologic findings, and treatment options. J Am Acad Dermatol 2002; 46: 477-490. https://doi.org/10.1067/mjd.2002.121358
NAKAMURA S, HASHIMOTO Y, TAKEDA K, NISHI K, ISHIDA-YAMAMOTO A, MIZUMOTO T et al. Two cases of male nipple leiomyoma: idiopathic leiomyoma and gynecomastia-associated leiomyoma. Am J Dermatopathol 2012; 34:287-291. https://doi.org/10.1097/dad.0b013e31822a3075
FAUTH CT, BRUECKS AK, TEMPLE W, ARLETTE JP, DIFRANCESCO LM. Superficial leiomyosarcoma: a clinicopathologic review and update. J Cutan Pathol 2010; 37: 269-276. https://doi.org/10.1111/j.1600-0560.2009.01405.x
WINCHESTER DS, HOCKER TL, BREWER JD, BAUM CL, HOCHWALT PC, ARPEY CJ et al. Leiomyosarcoma of the skin: clinical, histopathologic, and prognostic factors that influence outcomes. J Am Acad Dermatol 2014; 71: 919-925. https://doi.org/10.1016/j.jaad.2014.07.020
KRAFT S, FLETCHER CD. Atypical intradermal smooth muscle neoplasms: clinicopathologic analysis of 84 cases and a reappraisal of cutaneous "leiomyosarcoma". Am J Surg Pathol 2011; 35: 599-607. https://doi.org/10.1097/pas.0b013e31820e6093
SCHMIDT C, SCIACOVELLI M, FREZZA C. Fumarate hydratase in cancer: A multifaceted tumour suppressor. Semin Cell Dev Biol 2020; 98: 15-25. https://doi.org/10.1016/j.semcdb.2019.05.002
JIMÉNEZ ARISTU JI, PINÓS PAULA MA, DE PABLO CARDENAS A, JIMÉNEZ CALVO J, LOZANO URUÑUELA F, SARMIENTO GOMEZ C et al. Leiomyoma of scrotum: contribution of one case. Actas Urológicas Españolas 2003; 270:822-822-824. https://doi.org/10.1016/s0210-4806(03)73021-6
Instituto de Estadística de Navarra. Cifras de población. https://administracionelectronica.navarra.es/GN.InstitutoEstadistica.Web/InformacionEstadistica.aspx?R=1&E=8
Sociedad Española de Oncología Médica (SEOM). Las cifras del cáncer en España 2018. https://seom.org/seomcms/images/stories/recursos/Las_Cifras_del_cancer_en_Espana2018.pdf
SHEN TC, HSIA TC, HSIAO CL, LIN CL, YANG CY, SOH KS et al. Patients with uterine leiomyoma exhibit a high incidence but low mortality rate for breast cancer. Oncotarget. 2017 16; 8: 33014-33023. https//doi.org/10.18632/oncotarget.16520
AKIZAWA S. Angiomyoma: An analysis of 124 cases. Jikeikai MedJ 1980; 27:71-82.
KAGIMOTO Y, YAMASAKI K, SHIMADA-OHMORI R, NAN L, NUMATA Y, AIBA S. Positive correlation of vanilloid receptor subtype1 and prostaglandin E2 expression with pain in leiomyomas. J Dermatol 2017; 44: 690-694. https://doi.org/10.1111/1346-8138.13726
ALAM M, RABINOWITZ AD, ENGLER DE. Gabapentin treatment of multiple piloleiomyoma-related pain. J Am Acad Dermatol 2002; 46 (Suppl 1): S27-S29. https://doi.org/10.1067/mjd.2002.107970
HASEGAWA T, SEKI K, YANG P, HIROSE T, HIZAWA K. Mechanism of pain and cytoskeletal properties in angioleiomyomas: an immunohistochemical study. Pathol Int 1994; 44: 66-72. https://doi.org/10.1111/j.1440-1827.1994.tb02587.x
KAWAGISHI N, KASHIWAGI T, IBE M, MANABE A, ISHIDA-YAMAMOTO A, HASHIMOTO Y et al. Pleomorphic angioleiomyoma. Am J Dermatopathol 2000; 22: 268-271. https://doi.org/10.1097/00000372-200006000-00012
MARTINEZ JA, QUECEDO E, FORTEA JM, OLIVER V, ALIAGA A. Pleomorphic angioleiomyoma. Am J Dermatopathol 1996; 18: 409-412. https://doi.org/10.1097/00000372-199608000-00014
ZHU G, XIAO D, SUN P. Expression of estrogen and progesterone receptors in angioleiomyoma of the nasal cavity of six patients. Oncol Lett 2016; 11: 2359-2364. https://doi.org/10.3892/ol.2016.4230
SUÁREZ-PEÑARANDA JM, VIEITES B, EVGENYEVA E, VÁZQUEZ-VEIGA H, FORTEZA J. Male genital leiomyomas showing androgen receptor expression. J Cutan Pathol 2007; 34: 946-949. https://doi.org/10.1111/j.1600-0560.2007.00754.x
SUN C, ZOU J, WANG Q, WANG Q, HAN L, BATCHU N et al. Review of the pathophysiology, diagnosis, and therapy of vulvar leiomyoma, a rare gynecological tumor. J Int Med Res 2018; 46: 663-674. https://doi.org/10.1177/0300060517721796
SIEGLE JC, CARTMELL L. Vulvar leiomyoma associated with estrogen/progestin therapy. A case report. J Reprod Med 1995; 40: 147-148.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Anales del Sistema Sanitario de Navarra
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
La revista Anales del Sistema Sanitario de Navarra es publicada por el Departamento de Salud del Gobierno de Navarra (España), quien conserva los derechos patrimoniales (copyright ) sobre el artículo publicado y favorece y permite la difusión del mismo bajo licencia Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional (CC BY-SA 4.0). Esta licencia permite copiar, usar, difundir, transmitir y exponer públicamente el artículo, siempre que siempre que se cite la autoría y la publicación inicial en Anales del Sistema Sanitario de Navarra, y se distinga la existencia de esta licencia de uso.