Leiomyosarcoma of the scrotum: a case report with electron microscopy

Leiomyosarcoma of scrotum: case report

Scrotal leiomyosarcoma is rare tumor. It presents as a painless, slow-growing cutaneous lesion. It’s often mistaken for a benign condition. It is best treated by wide local excision. A case of scrotum leiomyosarcoma is presented in a 63 year old patient who was treated for the first time as having a benign lesion.

Cutaneous smooth muscle neoplasms: clinical features, histologic findings, and treatment options

Cutaneous smooth muscle is present in 3 separate locations: arrector pili muscles, blood vessel walls, and genital/areolar skin. Benign or malignant smooth muscle neoplasms may arise from each of these locations. This review discusses the pathogenesis, clinical manifestations, histologic findings, prognosis, treatment options, and controversial areas of cutaneous smooth muscle neoplasms. ( J Am Acad Dermatol 2002;46:477-90.)

LEARNING OBJECTIVE

At the completion of this learning activity, participants should be able to discuss the pathogenesis, clinical manifestations, histologic findings, prognosis, and treatment options of cutaneous smooth muscle neoplasms.

Leiomyosarcoma of the paratesticular region: a clinicopathologic study

The behavior of leiomyosarcoma (LMS) is site related, but there are limited data on such tumors presenting in the paratesticular region. Cases diagnosed as LMS of the paratesticular region from the files of three institutions were reviewed. Immunohistochemistry was performed in cases with available blocks, and follow-up information was obtained. From 31 cases originally diagnosed as LMS, 24 were retained after review. These were from men aged 34-86 years (mean 62 years; median 64 years) and involved the testicular tunica (10), spermatic cord (10), scrotal subcutis and dartos muscles (1 each), and the epididymis (1). Tumors ranged in size from 2-9 cm (mean 5 cm; median 4 cm). On immunohistochemical staining they expressed muscle-specific actin (13 of 14), smooth muscle actin (10 of 10), desmin (16 of 17), and CD34 (3 of 9); all of the latter three were strongly desmin-positive. Focal reactivity for cytokeratin (3 of 8) and S-100 protein (1 of 8) was seen. Follow-up information was available in 14 patients. Four (29%) had recurrences, in one case four times. Metastases to lymph nodes, lungs, or liver were seen in four patients (29%), of whom two had prior recurrences. Ten were alive with no evidence of disease (ANED), and four were dead of disease (DOD). Comparing outcome with tumor grade, all seven patients with grade 1 tumors (of whom two had recurrences) and all three with grade 2 tumors were ANED, whereas all four patients with grade 3 tumors were DOD. In summary, paratesticular LMSs are rare neoplasms. The majority in this site are low-grade, although high-grade lesions behave aggressively.

Tumors with smooth muscle differentiation

BACKGROUND

In the classification of tumors of soft tissue, modern schemes describe tumors by the normal adult tissue type the tumor resembles. Thus, tumors are described as smooth muscle tumors if the cells are differentiating towards smooth muscle. We may infer that in fact the tumor arose from smooth muscle, but this is only an inference. Tumors showing differentiation towards smooth muscle include hamartomas, benign tumors, and malignant tumors.

OBJECTIVE

This review article describes the clinical presentation and course, histology, and treatment recommendations for benign and malignant smooth muscle tumors.

METHODS

An extensive literature review of tumors with differentiation towards smooth muscle.

RESULTS

Benign tumors exhibiting differentiation towards smooth muscle include smooth muscle hamartoma and leiomyoma. Myofibroma is a third tumor that some have argued is a smooth muscle tumor rather than a fibroblastic tumor. Characteristic fusiform shaped cells with a round central nucleus arranged in fasicles suggest smooth muscle differentiation. Special stains such as phosphotungenistic acid-hemotoxilin, analine blue, and Masson's trichrome are helpful in differentiating muscle from collagen. Immunohistochemical stains are also helpful in establishing a diagnosis. With solitary tumors, treatment for cosmesis or for painful leiomyomas is not a problem. Multiple leiomyomas, which may be painful or sensitive to cold or touch, are a therapeutic challenge, with reports of multiple medications being attempted in the literature. Leiomyosarcoma are malignant tumors of smooth muscle. They may be cutaneous and presumably arise from the arrector pilorum muscle, or subcutaneous, where they are believed to arise from vascular smooth muscle. Cutaneous leiomyosarcomas frequently reoccur following excision, but rarely metastasize. Subcutaneous leiomyosarcomas frequently reoccur following excision and have a high metastatic rate. Several recent reports have documented an increased frequency of visceral leiomyosarcomas in immunosuppressed patients. These tumors have been found to contain the Epstein Barr virus. Treatment of leiomyosarcoma is wide excision.

CONCLUSIONS

Smooth muscle tumors are rare neoplasms that may confront the dermatologic surgeon. While leiomyomas are benign, their frequent sensitivity or pain necessitates treatment. Leiomyosarcomas are malignancies with a high reoccurrence rate, and when deep, a high metastatic rate. The finding of an increased frequency of visceral leiomyomas and leiomyosarcomas in immunosuppressed patients may imply an increased frequency of cutaneous leiomyomas and leiomyosarcomas in this patient population.

Leiomyosarcoma of scrotum

Leiomyosarcoma of the scrotum is a rare tumor that is best treated by wide local excision. Lymphatic metastasis is rare. To date a total of 14 cases have been reported.

A 37-pound scrotal leiomyosarcoma: a case report and literature review

We report a case of a 37-pound scrotal leiomyosarcoma. The literature is reviewed, and the presentation, diagnosis, treatment and survival of patients with scrotal leiomyosarcoma are discussed.

Leiomyosarcoma of the scrotum

A case of leiomyosarcoma arising from the dartos muscle of the scrotum is described. Review of the literature reveals only eight other cases, and aspects of management of these and our case are discussed.

Leiomyosarcoma of the dartos muscle

Smooth muscle is seen in the skin in three locations, the arrectores pilorum muscles, the wall of vessels and the specialized muscles in genital skin (the dartos, vulvar, and mamillary muscles of the scrotum, labia majora, and the breast, respectively). We report a case of a leiomyosarcoma of the dartos muscle in a 57-year-old man. The histological features of this tumor are similar to the previously reported cases of leiomyosarcomas of the skin thought to originate in arrectores pilorum muscles and the wall of vessels.

Retroperitoneal leiomyosarcoma: a light and electron microscopic study

Retroperitoneal leiomyosarcoma arising in a spermatic blood vessel is described. In addition to typical leiomyosarcoma, areas of atypical histiocyte-like cells and storiform pattern bearing a close resemblance to malignant fibrous histiocytoma, were seen. Ultrastructurally, cells with features of smooth muscle, partially differentiated cells with marginal densities and basal lamina and histiocyte-like giant cells were present. Phagocytosis of inflammatory cells by tumour cells with marginal densities and an investment of basal lamina was observed. It is suggested that the precursor cell in this lesion was a primitive mesenchymal cell showing varying degrees of smooth muscle differentiation and giant cell formation.