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Symplastic scrotal leiomyoma: a case report
© Philip et al; licensee BioMed Central Ltd. 2008
Received: 23 January 2008
Accepted: 09 September 2008
Published: 09 September 2008
Scrotal leiomyomas are rare tumours which are essentially benign. Recurrence and malignant transformation to leiomyosarcoma have been reported. However, a specific subgroup with increased bizarre nuclei showing increased mitosis raises the need for a closer follow-up. We report on such a case.
We report the case of a 65-year-old man who underwent a scrotal lump excision. Histology showed a well defined leiomyoma. The presence of nuclear pleomorphism and mitoses, just falling short of the criteria for malignancy, made prediction of biological behaviour difficult. The patient remains well on 4-year follow-up.
Histological evidence of increased mitosis raises the need for sustained follow-up in view of the malignant potential from the extent of mitosis. Immunohistochemistry helps in identifying those patients warranting close follow-up.
Leiomyoma of the scrotum is a rare entity described as a benign pathology. Immunohistochemistry helps differentiate this condition from a leiomyosarcoma. However, we raise the entity of symplastic scrotal leiomyoma with bizarre nuclei and increased mitosis on immunohistochemistry. The pattern of growth in this distinct subset is not known. Theoretically, there is a higher risk for malignant transformation. We discuss this situation and suggest the necessity for close follow-up.
Scrotal wall leiomyomas are rare, usually asymptomatic tunica dartos tumours, commonly seen in middle-aged Caucasian men . They are typically slow growing presenting in the fifth decade of life .
They are often less than 3 cm in diameter and are more commonly solitary than multiple . The solitary group is further categorised as angioleiomyoma, genital-areolar leiomyoma and piloleiomyoma ; it has been suggested that these tumours are myofibroblastic in origin . Typically, these lesions are poorly circumscribed, non-encapsulated tumours consisting of uniform spindle shaped cells arranged as interlacing fascicles with little or no pleomorphism, or mitoses [1, 3].
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 . Radiation should be avoided as it may induce malignant transformation . Recurrence and malignancy have been described .
In symplastic scrotal leiomyoma, the presence of nuclear pleomorphism and mitoses, just falling short of the criteria for malignancy, makes prediction of biological behaviour difficult. Immunohistochemistry helps identify this subgroup of patients who warrant close follow-up in view of the malignant potential.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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