Leiomyoma

Leiomyoma
Uterine lipoleiomyoma, a type of leiomyoma. H&E stain.
Classification and external resources
Specialty	oncology
ICD-10	D21, D25 (ILDS D21.M40)
ICD-9-CM	218
ICD-O	M8890/0-8894
MedlinePlus	dostinex
MeSH	D007889

A leiomyoma (plural leiomyomas or leiomyomata) (leio- + myo- + -oma, "smooth-muscle tumor") is a benign smooth muscle neoplasm that very rarely becomes cancer (0.1%). They can occur in any organ, but the most common forms occur in the uterus, small bowel, and the esophagus.

Leiomyoma enucleated from a uterus. External surface on left; cut surface on right

Uterus

Uterine fibroids are leiomyomata of the uterine smooth muscle. As other leiomyomata, they are benign, but may lead to excessive menstrual bleeding (menorrhagia), often cause anemia and may lead to infertility.

A rare form of these tumors is uterine lipoleiomyoma - benign tumors consisting of a mixture of adipocytes and smooth muscle cells. Uterine lipoleiomyomata have been observed together with ovarian and other pathologies and some of them may develop into liposarcoma.^[1][2][3] These tumors are monoclonal, and non-random chromosomal abnormalities have been seen in 40% of the tumors.

Gallbladder

Mesenchymal neoplasms of the gallbladder are rare and in particular leiomyomas of the gallbladder have been rarely reported, all of them in patients with immune system disorders. Although, recently, a case was reported in absence of associated immunodeficiency at Monash Hospital in Melbourne Australia in a healthy 39-year-old woman with no symptoms.^[4]

Skin

Leiomyomas of the skin are generally (1) acquired, and (2) divided into several categories:^[5][6]

• Solitary cutaneous leiomyoma
• Multiple cutaneous (or pilar) leiomyomas arising from the arrectores pilorum muscles
• Angioleiomyomas (Vascular leiomyomas) that are thought to arise from vascular smooth muscle
• Dartoic (or genital) leiomyomas originating in the dartos muscles of the genitalia, areola, and nipple
• Angiolipoleiomyoma

Small intestines

Leiomyoma is the most common benign tumor of small bowel. Approximately 50% of cases are found in the jejunum, followed by the ileum in 31% of cases. Almost one half of all lesions are less than 5 centimeters.^[7]

Other locations, metastatic leiomyoma

• Metastatic leiomyoma are an extremely rare complication after surgery to remove the uterus for uterine fibroids. The most frequent sites of occurrence are the lungs and pelvis. The lesions are hormonally responsive.^[8][9][10]
• Fibromyoma of the breast is an extremely rare benign breast neoplasm. Most reports in literature mention a history of hysterectomy for uterine fibroids, although the question of whether these fibromyomas are possibly metastases of the uterine fibroids has not been investigated. An alternative hypothesis is an origin from the smooth muscle of the nipple.

Familial leiomyoma

• Associated with papillary variant of renal cell carcinoma and multiple cutaneous leiomyoma. Defect is in the fumarate hydratase gene in the long arm of chromosome 1.

See also

• Leiomyosarcoma

References

1. Pedeutour, F.; Quade, B. J.; Sornberger, K.; Tallini, G.; Ligon, A. H.; Weremowicz, S.; Morton, C. C. (2000). "Dysregulation ofHMGIC in a uterine lipoleiomyoma with a complex rearrangement including chromosomes 7, 12, and 14". Genes, Chromosomes and Cancer 27 (2): 209–215. doi:10.1002/(SICI)1098-2264(200002)27:2<209::AID-GCC14>3.0.CO;2-U. PMID 10612811.
2. McDonald, A. G.; Cin, P. D.; Ganguly, A.; Campbell, S.; Imai, Y.; Rosenberg, A. E.; Oliva, E. (2011). "Liposarcoma Arising in Uterine Lipoleiomyoma". The American Journal of Surgical Pathology 35 (2): 221–227. doi:10.1097/PAS.0b013e31820414f7. PMID 21263242.
3. Walid MS, Heaton RL. "Case report of a cervical lipoleiomyoma with an incidentally discovered ovarian granulosa cell tumor – imaging and minimal-invasive surgical procedure". GMS Ger Med Sci 8 (26).
4. Segura-Sampedro, J. J.; Alamo-Martínez, J. M.; Cañete-Gómez, J.; Suárez-Artacho, G.; González-Cantón, J. R.; Gómez-Bravo, M. Á.; Padillo-Ruiz, F. J. (2012). "Gallbladder leiomyoma in absence of immune system disorders: An unusual diagn". Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva 104 (7): 382–384. doi:10.4321/S1130-01082012000700009. PMID 22849501.
5. Freedberg, Irwin M.; Fitzpatrick, Thomas B. (2003). Fitzpatrick's dermatology in general medicine (6th ed.). New York: McGraw-Hill, Medical Pub. Division. p. 1033. ISBN 0-07-138076-0.
6. Odom, Richard B.; Davidsohn, Israel; James, William D.; Henry, John Bernard; Berger, Timothy G.; Dirk M. Elston (2006). Andrews' diseases of the skin: clinical dermatology (10th ed.). Saunders Elsevier. p. 627. ISBN 0-7216-2921-0.
7. Michael P. Buetow, M.D. "Leiomyoma of Jejunum". Applied Radiology Online. Retrieved 2007-03-21.
8. Patton, K.; Cheng, L.; Papavero, V.; Blum, M.; Yeldandi, A.; Adley, B.; Luan, C.; Diaz, L.; Hui, P.; Yang, X. J. (2006). "Benign metastasizing leiomyoma: clonality, telomere length and clinicopathologic analysis". Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 19 (1): 130–140. doi:10.1038/modpathol.3800504. PMID 16357844.
9. Beck, M. M.; Biswas, B.; d'Souza, A.; Kumar, R. (2012). "Benign metastasising leiomyoma after hysterectomy and bilateral salpingo-oophorectomy". Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 18 (2): 153–155. PMID 22477740.
10. Rivera, J. A.; Christopoulos, S.; Small, D.; Trifiro, M. (2004). "Hormonal Manipulation of Benign Metastasizing Leiomyomas: Report of Two Cases and Review of the Literature". Journal of Clinical Endocrinology & Metabolism 89 (7): 3183–3188. doi:10.1210/jc.2003-032021. PMID 15240591.

External links

• humpath #4835 (Pathology images)
• Laser myomectomy
• Laparoscopic myomectomy.
• Uterine fibroids at Merck Manual of Diagnosis and Therapy Professional Edition
• Esophageal Leiomyoma at eMedicine
• Atlas of Pathology uterine leimyoma