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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 4  |  Issue : 2  |  Page : 238-240

Leiomyoma of scrotum


Department of Pathology, IGMC, Shimla, Himachal Pradesh, India

Date of Web Publication20-Dec-2016

Correspondence Address:
Sarita Asotra
Flat No. 5, Block No. 5, Phase 3, New Shimla - 171 009, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-4848.196189

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  Abstract 

Leiomyoma is a benign tumor of smooth muscle. Leiomyoma originating from the scrotum is rare. We report here a case of 50-year-old male who presented with a lump in the left side of scrotum. Clinically, it was diagnosed as sebaceous cyst and was excised. The histopathology showed findings consistent with leiomyoma. There was no cytological atypia. The final diagnosis of solitary scrotal leiomyoma was given.

Keywords: Genital leiomyoma, leiomyoma, scrotum


How to cite this article:
Asotra S. Leiomyoma of scrotum. Arch Med Health Sci 2016;4:238-40

How to cite this URL:
Asotra S. Leiomyoma of scrotum. Arch Med Health Sci [serial online] 2016 [cited 2017 Oct 20];4:238-40. Available from: http://www.amhsjournal.org/text.asp?2016/4/2/238/196189


  Introduction Top


Scrotal leiomyomas are rare tumors which are essentially benign. Recurrence and malignant transformation to leiomyosarcoma have been reported. Immunohistochemistry helps differentiate this condition from a leiomyosarcoma, however, a specific subgroup of symplastic scrotal leiomyoma with increased bizarre nuclei showing increased mitosis raises the need for a closer follow-up.[1] The pattern of growth in this distinct subset is not known. Theoretically, there is a higher risk for malignant transformation.

Leiomyoma is a benign tumor of smooth muscles. Superficial leiomyoma of skin and subcutaneous tissue may be of three types;

  1. Tumor of arrector pili muscle (piloleiomyoma),
  2. Tumors of smooth muscles of blood vessels (angioleiomyoma), and
  3. Genital leiomyoma (from the smooth muscles of nipple, vulva, and scrotum).


Smooth muscle tumors of scrotum were first described by Forsters in 1858 and are reported to be extremely rare. Siegal and Gaffey demonstrated the rarity of this tumor finding only 11 cases in a review of 11,000 cases of scrotal tumor. Scrotal leiomyoma is the uncommon tumors that arise from the subcutaneous tissue or dartos muscle.[2]


  Case Report Top


A 50-year-old male presented with the complaints of a painless lump on the left side of the scrotum for 8 months. Physical examination revealed a soft to firm, nontender, mobile, and round lump of 4 cm × 4 cm × 3 cm on the lateral aspect of right scrotum. It could be felt separate from testes or the adnexal structures. The overlying skin was normal without any ulceration. Both tests were normal without any palpable inguinal lymph node.

The lump was diagnosed as a sebaceous cyst. It was excised and sent for histopathological evaluation.

Grossly, it was a single, skin covered, and firm tissue mass of 4 cm × 3 cm × 2.5 cm. Cut surface showed solid, homogeneous character with whorling.

Microscopically, a well-circumscribed tumor was seen composed of interlacing bundles of smooth muscles with varying amount of admixed collagen, well delineated from the skin [Figure 1] and [Figure 2]. Individual muscle cells were uniform in size and shape with oval nuclei and bipolar cytoplasm. There was no evidence of cytological atypia or mitotic figures. Masson trichrome stain showed red fascicles of smooth muscle fibers admixed with collagen fibers green [Figure 3].
Figure 1: Photomicrograph showing well-circumscribed tumor composed of interlacing bundles of smooth muscles (H and E, ×100)

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Figure 2: Photomicrograph showing smooth muscle cells with oval nuclei and bipolar cytoplasm with varying amount of admixed collagen (H and E, ×400)

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Figure 3: Photomicrograph showing pink fascicles of smooth muscle fibres admixed with collagen fibres (green) (Masson trichrome stain, ×400)

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  Discussion Top


Genital leiomyoma includes those involving scrotum, vulva or nipple. Scrotal leiomyoma is rare, usually asymptomatic typically slow growing presenting in the fifth decade of life.[3]

They are often >3 cm in diameter and are more commonly solitary than multiple. The solitary group is further categorized as angioleiomyoma, genital-areolar leiomyoma, and piloleiomyoma; it has been suggested that these tumors are myofibroblastic in origin.[4] Typically, these lesions are poorly circumscribed, nonencapsulated tumors consisting of uniform spindle-shaped cells arranged as interlacing fascicles with little or no pleomorphism or mitoses. Scrotal leiomyoma arises in the dartos muscle and is a rare tumor with, <50 cases reported. It occurs most often in white men between fourth and sixth decades of life. Patients usually present with painless solitary small cutaneous lesion measuring 1-14 cm with an average of 6.4 cm.[5] The painless nature of the tumor corresponds well with the slow growing nature of the tumor. Because of the asymptomatic, painless, and slow growing nature of the tumor, patients usually present late with an average of 7.6 years between the patients recognition of the tumor and its surgical removal.[6] In our case, the patient presented within 2 months of lump recognition.

Simple surgical excision is curative; surgery for large lesions should be conservative if its cutaneous origin is clearly separate from the testis or adnexal structures.[7] Radiation should be avoided as it may induce malignant transformation. Recurrence and malignancy have been described.[8]


  Conclusion Top


This case demonstrates that leiomyoma should be considered in the differential diagnosis of the scrotal tumors to avoid the possibility of erroneous diagnosis and treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Sherwani RK, Rahman K, Akhtar K, Zaheer S, Hassan MJ, Haider A. Leiomyoma of scrotum. Indian J Pathol Microbiol 2008;51:72-3.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Sevilla Chica F, Meseguer García P, Roca Estellés MJ, Gómez Castro A, Mola Arizo MJ, Sala Aznar A. Atypical or bizarre leiomyoma of the scrotum. Report of one case and bibliographic review. Arch Esp Urol 2004;57:428-31.  Back to cited text no. 2
    
3.
Chiong E, Tan KB, Siew E, Rajwanshi A, See H, Esuvaranathan K. Uncommon benign intrascrotal tumours. Ann Acad Med Singapore 2004;33:351-5.  Back to cited text no. 3
    
4.
Usmani N, Merchant W, Yung A. A case of cutaneous symplastic leiomyoma — A rare variant of cutaneous pilar leiomyoma. J Cutan Pathol 2008;35:329-31.  Back to cited text no. 4
    
5.
Kim NR, Sung CO, Han J. Bizarre leiomyoma of the scrotum. J Korean Med Sci 2003;18:452-4.  Back to cited text no. 5
    
6.
Cabello Benavente R, López Martínez-Bernal B, Verdú Tartajo F, Monzó JI, Castaño González I, Moralejo Gárate M, et al. Giant bizarre scrotal leiomyoma. Arch Esp Urol 2004;57:847-51.  Back to cited text no. 6
    
7.
Rao S, Fimate P, Ramakrishnan R, Rajendiran S. Atypical leiomyoma of scrotum. J Cutan Aesthet Surg 2012;5:216-7.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Li SL, Han JD. A case report of atypical scrotal leiomyoma. Case Rep Dermatol 2013;5:316-20.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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