๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Genital leiomyoma
Genital leiomyoma
Clinical features Genital leiomyoma comprises those lesions arising from the vulva, scrotum, and nipple. Tumors arising in the vulva and scrotum are distinctive from other cutaneous leiomyomas including pilar leiomyoma and angioleiomyoma.1 Leiomyomas arising in the nipple are similar to pilar leiomyoma.
often with a single cell type predominating.4,18,19 Lesions with a spindled cell component are very similar to those found in the uterus and consist of bundles of cells with well-defined eosinophilic cytoplasm, vesicular cigar-shaped nuclei, and an inconspicuous nucleolus. Focal myxoid change and hyalinization are commonly seen and sometimes this results in a plexiform appearance. Epithelioid tumor cells have abundant eosinophilic or pale-staining cytoplasm.
Because of the rarity of vulval smooth muscle tumors, it is often difficult to separate benign lesions from those with potential for local recurrence or metastasis (see below). It has been suggested that a tumor with any evidence of mitotic activity, nuclear pleomorphism, or an infiltrative margin should be regarded as having at least the potential for local recurrence.4 In such cases, excision with a margin of at least 1โฏcm should be recommended.4
Vulval leiomyomas are relatively rare and present mainly in women of reproductive age as an asymptomatic swelling.1โ5 Clinical features are not distinctive. Tumors are subcutaneous, well circumscribed, and are often clinically diagnosed as a cyst. The majority of benign lesions are less than 5โฏcm in diameter and present in the labia. Rare cases arise in the clitoris.6 Tumors may increase in size during pregnancy and also in association with estrogen/progesterone replacement therapy.7 Benign tumors are typically well-circumscribed and small, but only histologic examination allows for distinction between benign, low-grade malignant and malignant tumors.
In males,8 it presents as a painless, slow-growing, palpable mass (papule or nodule), and/or difficulty with micturition9 if it affects the penis; or swelling of the scrotum where it arises from the tunica dartos scroti.1,10โ12 Scrotal tumors are less common and tend to be larger than their vulval counterparts.13,14 They present as an asymptomatic mass that may occasionally be polypoid.14 Rare cases are associated with prominent warty epidermal hyperplasia and resemble condyloma acuminatum.15 Other benign smooth muscle lesions of the scrotum such as hamartoma of the dartos muscle are exceedingly rare.16
Since scrotal leiomyomas are so rare, there is even less information relating to their histologic evaluation. Symplastic scrotal leiomyomas may have an ill-defined infiltrative margin and can display cytological atypia ranging from moderate to severe.20,21 The latter, however, is degenerative in nature with frequent multinucleated cells, low nuclear/cytoplasmic ratio, and smudged chromatin.21 Lesions are also smaller and less cellular than leiomyosarcomas and lack mitotic activity.