Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Leiomyoma Workup

  • Author: Kyle L Horner, MD, MS; Chief Editor: William D James, MD  more...
 
Updated: Apr 21, 2014
 

Laboratory Studies

See the list below:

  • The measurement of hemoglobin and/or hematocrit levels might be considered in patients with multiple leiomyomas because erythrocytosis is reported in rare cases.
Next

Imaging Studies

See the list below:

  • Imaging studies are not routinely performed for leiomyomas; however, angioleiomyomas do have characteristic findings on ultrasound and magnetic resonance images.
    • On ultrasound images, angioleiomyomas show well-defined margins and a homogeneous structure suggestive of their benign nature. On color Doppler, they show high resistance in intratumor arteries, suggesting the presence of muscular arteries.[11]
    • Doppler is useful in patient assessment before uterine artery embolization for uterine leiomyoma.[6]
    • MRI cannot differentiate between the different histological subtypes of angioleiomyomas; however, images show mixed hyperintense and isointense areas compared with skeletal muscle, with a hypointense rim corresponding to a fibrous capsule on T2-weighed images.[11, 18]
Previous
Next

Procedures

See the list below:

  • Tissue examination is necessary to establish the diagnosis. Therefore, a partial or excisional biopsy is indicated.
Previous
Next

Histologic Findings

Leiomyomas are smooth muscle tumors that are generally well differentiated. The characteristic smooth muscle nuclei are elongated with blunt ends, and they are often described as cigar or eel shaped. When these fibers are cut in cross-section, perinuclear vacuolization may be appreciated. With electron microscopy, the smooth muscle cells of a leiomyoma appear normal.

Piloleiomyomas occur mainly in the reticular dermis and are not encapsulated. The smooth muscle bundles of these tumors are interlaced with variable amounts of collagen. The rate of mitotic activity, if present, is low.

Genital leiomyomas are similar to piloleiomyomas in their histologic appearance.

In contrast, angioleiomyomas contain many dilated vascular spaces amidst smooth muscle bundles arranged in a more concentric fashion. These vascular spaces are lined by an endothelium. For further distinction, angioleiomyomas are well circumscribed or encapsulated and contain minimal collagen. In addition, larger angioleiomyomas frequently have areas of mucinous alteration.

Three histologic subtypes of angioleiomyomas are based on differences in the vascular channels: solid or capillary, cavernous, and venous. The solid or capillary type contains many small vascular spaces. Cavernous tumors have dilated vascular spaces with only small amounts of smooth muscle. The venous subtype contains veins with thick muscular walls.

Special stains can be used to distinguish smooth muscle from collagen, both of which are pink-red with hematoxylin-eosin stain. The Masson trichrome stain highlights smooth muscle as dark red and collagen as blue-green. With aniline blue stains, smooth muscle appears red and collagen appears blue. A van Gieson stain results in yellow smooth muscle contrasted against red collagen. With phosphotungstic acid–hematoxylin (PTAH) stain, myofibrils are purple. Immunohistochemical staining for desmin and actin, markers of smooth muscle differentiation, can be performed to detect these markers in leiomyomas. Interestingly, the stromal cells within an angiomyoma lack the human progenitor cell antigen CD34.[19]

Previous
 
 
Contributor Information and Disclosures
Author

Kyle L Horner, MD, MS Physician, Grace Dermatology and Micrographic Surgery, Lebanon, OR

Kyle L Horner, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Marion C Miethke, MD Clinical Assistant Professor, Department of Internal Medicine, Section of Dermatology, University of Washington

Marion C Miethke, MD is a member of the following medical societies: Phi Beta Kappa

Disclosure: Nothing to disclose.

Gregory J Raugi, MD, PhD Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle School of Medicine; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD Herman Beerman Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Dermatopathology, Pennsylvania Academy of Dermatology

Disclosure: Received royalty from Lippincott Williams Wilkins for textbook editor.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Carrie L Kovarik, MD Assistant Professor of Dermatology, Dermatopathology, and Infectious Diseases, University of Pennsylvania School of Medicine

Carrie L Kovarik, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

References
  1. Holst VA, Junkins-Hopkins JM, Elenitsas R. Cutaneous smooth muscle neoplasms: clinical features, histologic findings, and treatment options. J Am Acad Dermatol. 2002 Apr. 46(4):477-90; quiz, 491-4. [Medline].

  2. Gokdemir G, Sakiz D, Koslu A. Multiple cutaneous leiomyomas of the nipple. J Eur Acad Dermatol Venereol. 2006 Apr. 20(4):468-9. [Medline].

  3. Brooks JK, Nikitakis NG, Goodman NJ, Levy BA. Clinicopathologic characterization of oral angioleiomyomas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Aug. 94(2):221-7. [Medline].

  4. Nagata S, Nishimura H, Uchida M, Hayabuchi N, Zenmyou M, Fukahori S. Giant angioleiomyoma in extremity: report of two cases. Magn Reson Med Sci. 2006 Jul. 5(2):113-8. [Medline].

  5. Yagi K, Hamada Y, Yasui N. A leiomyoma arising from the deep palmar arterial arch. J Hand Surg [Br]. Dec 2006. 31(6):680-2. [Medline].

  6. Naguib NN, Nour-Eldin NE, Serag Eldin F, Mazloum YZ, Agameya AF, Abou Seif S, et al. Uterine Artery Embolization for Uterine Leiomyoma: Role of Uterine Artery Doppler in the Pre-Interventional, Interventional and Post-interventional Patient Workup. Ultrasound Obstet Gynecol. 2011 Dec 16. [Medline].

  7. Virchow R. Ueber Makroglossie und pathologische Neubildung quergestreifter Muskelfasern. Virchows Arch (Pathol Anat). 1854. 7:126-38.

  8. Kloepfer HW, Krafchuk J, Derbes V. Hereditary multiple leiomyoma of the skin. Am J Hum Genet. 1958 Mar. 10(1):48-52. [Medline].

  9. Utikal J, Haus G, Poenitz N, Koenen W, Back W, Dippel E. Cutaneous leiomyosarcoma with myxoid alteration arising in a setting of multiple cutaneous smooth muscle neoplasms. J Cutan Pathol. 2006 Sep. 33 Suppl 2:20-3. [Medline].

  10. Spies JB, Bradley LD, Guido R, Maxwell GL, Levine BA, Coyne K. Outcomes from leiomyoma therapies: comparison with normal controls. Obstet Gynecol. 2010 Sep. 116(3):641-52. [Medline].

  11. Ramesh P, Annapureddy SR, Khan F, Sutaria PD. Angioleiomyoma: a clinical, pathological and radiological review. Int J Clin Pract. 2004 Jun. 58(6):587-91. [Medline].

  12. Alam NA, Bevan S, Churchman M, Barclay E, Barker K, Jaeger EE, et al. Localization of a gene (MCUL1) for multiple cutaneous leiomyomata and uterine fibroids to chromosome 1q42.3-q43. Am J Hum Genet. 2001 May. 68(5):1264-9. [Medline].

  13. Alam NA, Olpin S, Rowan A, Kelsell D, Leigh IM, Tomlinson IP, et al. Missense mutations in fumarate hydratase in multiple cutaneous and uterine leiomyomatosis and renal cell cancer. J Mol Diagn. 2005 Oct. 7(4):437-43. [Medline].

  14. Alam NA, Olpin S, Leigh IM. Fumarate hydratase mutations and predisposition to cutaneous leiomyomas, uterine leiomyomas and renal cancer. Br J Dermatol. 2005 Jul. 153(1):11-7. [Medline].

  15. Wei MH, Toure O, Glenn GM, Pithukpakorn M, Neckers L, Stolle C, et al. Novel mutations in FH and expansion of the spectrum of phenotypes expressed in families with hereditary leiomyomatosis and renal cell cancer. J Med Genet. 2006 Jan. 43(1):18-27. [Medline].

  16. Badeloe S, van Geel M, van Steensel MA, Bastida J, Ferrando J, Steijlen PM, et al. Diffuse and segmental variants of cutaneous leiomyomatosis: novel mutations in the fumarate hydratase gene and review of the literature. Exp Dermatol. 2006 Sep. 15(9):735-41. [Medline].

  17. Horton E, Dobin SM, Debiec-Rychter M, Donner LR. A clonal translocation (7;8)(p13;q11.2) in a leiomyoma of the vulva. Cancer Genet Cytogenet. 2006 Oct 1. 170(1):58-60. [Medline].

  18. Woertler K. Soft tissue masses in the foot and ankle: characteristics on MR Imaging. Semin Musculoskelet Radiol. 2005 Sep. 9(3):227-42. [Medline].

  19. Nakayama H, Enzan H, Miyazaki E, Kuroda N, Toi M. Lack of CD34 positive stromal cells within angiomyomas (vascular leiomyomas). J Clin Pathol. 2002 May. 55(5):395-6. [Medline].

  20. Batchelor RJ, Lyon CC, Highet AS. Successful treatment of pain in two patients with cutaneous leiomyomata with the oral alpha-1 adrenoceptor antagonist, doxazosin. Br J Dermatol. 2004 Apr. 150(4):775-6. [Medline].

  21. Alam M, Rabinowitz AD, Engler DE. Gabapentin treatment of multiple piloleiomyoma-related pain. J Am Acad Dermatol. 2002 Feb. 46(2 Suppl Case Reports):S27-9. [Medline].

  22. Scheinfeld N. The role of gabapentin in treating diseases with cutaneous manifestations and pain. Int J Dermatol. 2003 Jun. 42(6):491-5. [Medline].

  23. Sifaki MK, Krueger-Krasagakis S, Koutsopoulos A, Evangelou GI, Tosca AD. Botulinum toxin type A--treatment of a patient with multiple cutaneous piloleiomyomas. Dermatology. 2009. 218(1):44-7. [Medline].

  24. Onder M, Adisen E. A new indication of botulinum toxin: leiomyoma-related pain. J Am Acad Dermatol. 2009 Feb. 60(2):325-8. [Medline].

  25. Baird DD, Hill MC, Schectman JM, Hollis BW. Vitamin d and the risk of uterine fibroids. Epidemiology. 2013 May. 24(3):447-53. [Medline].

  26. Gravvanis A, Kakagia D, Papadopoulos S, Tsoutsos D. Dermal skin template for the management of multiple cutaneous leiomyomas. J Cutan Med Surg. 2009 Mar-Apr. 13(2):102-5. [Medline].

  27. Abraham Z, Cohen A, Haim S. Muscle relaxing agent in cutaneous leiomyoma. Dermatologica. 1983. 166(5):255-6. [Medline].

  28. Archer CB, Greaves MW. Assessment of treatment for painful cutaneous leiomyomas [letter]. J Am Acad Dermatol. 1987 Jul. 17(1):141-2. [Medline].

  29. Archer CB, Whittaker S, Greaves MW. Pharmacological modulation of cold-induced pain in cutaneous leiomyomata. Br J Dermatol. 1988 Feb. 118(2):255-60. [Medline].

  30. Chuang GS, Martinez-Mir A, Geyer A, Engler DE, Glaser B, Cserhalmi-Friedman PB, et al. Germline fumarate hydratase mutations and evidence for a founder mutation underlying multiple cutaneous and uterine leiomyomata. J Am Acad Dermatol. 2005 Mar. 52(3 Pt 1):410-6. [Medline].

  31. Fernandez-Pugnaire MA, Delgado-Florencio V. Familial multiple cutaneous leiomyomas. Dermatology. 1995. 191(4):295-8. [Medline].

  32. Fitzpatrick JE, Mellette JR Jr, Hwang RJ, Golitz LE, Zaim MT, Clemons D. Cutaneous angiolipoleiomyoma. J Am Acad Dermatol. 1990 Dec. 23(6 Pt 1):1093-8. [Medline].

  33. García Muret MP, Pujol RM, Alomar A, Calaf J, de Moragas JM. Familial leiomyomatosis cutis et uteri (Reed's syndrome). Arch Dermatol Res. 1988. 280 Suppl:S29-32. [Medline].

  34. Geddy PM, Gray S, Reid WA. Mast cell density and PGP 9.5-immunostained nerves in angioleiomyoma: their relationship to painful symptoms. Histopathology. 1993 Apr. 22(4):.5-immunostained nerves in angioleiomyoma: their relationship to painful sympto. [Medline].

  35. Laporte M, Achten G, Gheeraert P, Lowy M, Vokaer A. [Multiple leiomyoma treated with nifedipine: association with an astrocytoma]. Dermatologica. 1985. 171(6):486-90. [Medline].

  36. Newman PL, Fletcher CD. Smooth muscle tumours of the external genitalia: clinicopathological analysis of a series [published erratum appears in Histopathology 1991 Aug;19(2):198]. Histopathology. 1991 Jun. 18(6):523-9. [Medline].

  37. 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 Feb. 19(1):2-9. [Medline].

  38. Spencer JM, Amonette RA. Tumors with smooth muscle differentiation. Dermatol Surg. 1996 Sep. 22(9):761-8. [Medline].

  39. Thompson JA Jr. Therapy for painful cutaneous leiomyomas. J Am Acad Dermatol. 1985 Nov. 13(5 Pt 2):865-7. [Medline].

  40. Vellanki LS, Camisa C, Steck WD. Familial leiomyomata. Cutis. 1996 Jul. 58(1):80-2. [Medline].

  41. Venencie PY, Bigel P, de la Charrière O, Lemonnier V, Thébaut-Gerbaud D, Saurat JH. [Multiple cutaneous leiomyomatosis. Treatment with phenoxybenzamine]. Ann Dermatol Venereol. 1982. 109(9):819-20. [Medline].

  42. Venencie PY, Puissant A, Boffa GA, Sohier J, Duperrat B. Multiple cutaneous leiomyomata and erythrocytosis with demonstration of erythropoietic activity in the cutaneous leiomyomata. Br J Dermatol. 1982 Oct. 107(4):483-6. [Medline].

 
Previous
Next
 
These multiple hyperpigmented nodules are piloleiomyomas on an upper extremity.
Upon closer inspection, one can appreciate that these piloleiomyomas are superficial dermal nodules.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.