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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.

Imaging Studies

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  • 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]


See the list below:

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

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]

Contributor Information and Disclosures

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.


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.

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These multiple hyperpigmented nodules are piloleiomyomas on an upper extremity.
Upon closer inspection, one can appreciate that these piloleiomyomas are superficial dermal nodules.
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