Solitary cutaneous leiomyoma

Case contributed by Rodney Strahan


20 year history of swelling anterior to left ankle.

Patient Data

Age: 65 years
Gender: Male

4 cm mass anterior to the ankle joint with amorphous calcification within a well circumscribed soft tissue mass. No bone abnormality seen although it is difficult on plain films to exclude bone or joint involvement.

At surgery there was no bone or joint involvement identified.

Histopathology of resected specimen:

This is a well circumscribed lesion with bland spindle cells, consistent with benign leiomyoma. Immunocytochemical studies show tumor cells are positive for smooth muscle markers (actin, caldesmon, desmin), and are negative for S100 and CD34.

DIAGNOSIS: Soft tissue lesion left leg: Benign leiomyoma; negative for malignancy. 

Case Discussion

The majority of imaged leiomyomas are associated with the smooth muscle of the female reproductive organs (uterus, cervix and broad ligament) and so have a female predominance. They are commonly known as fibroids. However, leiomyomas can be found where smooth muscle is present, such as the urinary bladder, prostate, esophagus, stomach, colon and trachea. There is also smooth muscle cells in the skin, which is where this case would have arisen. Cutaneous leiomyomas are often multiple small skin lesions that do not need imaging. This case has a long history (20 years) and so that has given time for degeneration and calcification, which is commonly seen in fibroids.

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