Prostatic leiomyoma

Last revised by Joachim Feger on 11 Feb 2022

Prostatic leiomyomas are benign mesenchymal tumors of the prostate.

Prostatic leiomyomas are very rare 1-3.

The diagnosis of prostatic leiomyoma is based on histology.

Prostatic leiomyomas can present with voiding difficulties or obstructive symptoms 1.

Complications of prostatic leiomyomas include acute urinary retention 1.

Leiomyomas of the prostate are characterized as benign smooth muscle tumors without any glandular elements located within the prostate or in a juxta-prostatic position 1-4.

Grossly tumors have been described as well-circumscribed with a glistening or smooth surface and a multilocular cystic cut surface 5.

Microscopically leiomyomas of the prostate are characterized by the following histologic features 5,6:

  • bland spindle cells with a prominent eosinophilic cytoplasm
  • organized fascicular architecture
  • no or rare nuclear atypia
  • no or scarce mitoses
  • no necrosis

Immunohistochemistry stain should express desmin or smooth muscle actin but should be negative for CD34 1-3.

On transrectal ultrasound, leiomyomas have been described as nonspecific hypoechoic or hyperechoic masses 2-4.

Computed tomography might show a heterogeneously enhancing but otherwise noninvasive appearing soft tissue mass 2,4.

On prostate or pelvic MRI  have been characterized as well-delineated and without signs of invasive behavior 2-4.

  • T1: overall isointense
  • T2: hypointense to slightly hyperintense with hyperintense foci (compared to muscle)
  • DWI: diffusion restriction (hyperintense on high-b value, hypointense on ADC)
  • DCE (Gd): homogeneous slow enhancement

The radiological report should include a description of the following:

  • form, extent and location of the tumor
  • description of its borders
  • relation to seminal vesicles, bladder and rectum

Management options consist of surgical excision either as transurethral resection or prostatectomy. Prognosis is excellent if excised completely 1-3. More recent options include prostate artery embolization or active surveillance in asymptomatic patients 2,3.

The first case of prostatic leiomyoma was reported by Lebec et al in 1876 1. The definition has been formulated by Kaufmann and Berneike in 1951 1,7.

Conditions that may be mimicking the clinical presentation or imaging appearance of  prostatic leiomyomas  include 1:

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