Leiomyoma is a benign tumour of smooth muscle orig ... followed by tongue (18.30%), cheeks and palate (15.49%), gingiva ... d benign spindle cell lesion.
International journal of Multidisciplinary Research and information
IJMRI
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RESEARCH ARTICLE
STERNOCLEIDOMASTOID LEIOMYOMA – A RARE ENTITY Bakshi Jaimanti and Kiran Joshi Department of Otolaryngology and Head Neck Surgery,, PGIMER, Chandigarh AR TI CL E
I NF O
Article History: Received 15th, July, 2015 Received in revised form 28th, July, 2015 Accepted 6th, August, 2015 Published online 15th, August, 2015 Key words:
AB STR A CT Leiomyomas are benign tumors arising from smooth muscle, most commonly seen in uterine myometrium, gastrointestinal tract, skin and lower extremities of middle middleaged women. Leiomyomas of head and neck region account for less than 1% of all leiomyomas. The most common site of leiomyoma in the head and neck region is the lips (27.46%) followed by tongue (18.30%), cheeks and palate (15.49%), gingiva (8.45%) and mandible (5.63%). The purpose of this article is to present a rare case of sternocleidomastoid sternocle leiomyoma with review of the literature.
sternocleidomastoid, Leiomyoma head neck y words:
GDP (Gross Domestic Product), SME (Small and Medium Enterprises), SCM (Supply Chain Management), ERP (Enterprise Resource CUGJaimanti (ClosedMS User CopyrightPlanning), © 2015 Bakshi This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted Groups) use, distribution, and reproduction in any medium, provided the original work is properly cited.
INTRODUCTION
Preoperative fine needle aspiration cytology of the left neck swelling showed benign spindle cell lesion.
Leiomyoma is a benign tumour of smooth muscle origin. Since head and neck region lacks smooth muscle, occurrence of leiomyoma in this area is rare. Primary leiomyoma of head and neck account for 12% of all leiomyoma.[1] Leiomyomas are most commonly found in uterine myometrium(95%) followed by skin(3%), gastrointestinal tract (1.5%) and lesser than 1% seen in the head and neck region. Here we report a rare case of sternocleidomastoid leiomyoma with a review of literature.
Contrast MRI neck showed ill defined 3x2.5x2.7 cm T2 hyperintense,T1 isointense, enhancing lesion in left posterior cervical space with signal voids in the mass.? mesenchymal ? neurilemmal tumor (fig. 2). CT Angio revealed anteromedial displacement and kinking of left IJV by the lesion, carotids were normal bilaterally. Total urinary VMA was 7.5
Case Report A 50 year old female patient reported to our outpatient department with complaint of swelling in the left upper part of neck for 1 year. The swelling was occasionally painful, slow growing and esthetically unacceptable for the patient. Past history of hypertension for 2 years was noted, for which patient pat was on antihypertensive drug. Clinical findings The swelling was approximately 4 x 3 cm , solitary ,firm to hard , ovoid in shape, nonpulsatile, with restricted mobility vertically with well defined margin, on left upper neck at level 3(fig. 1).. Overlying skin was normal, transillumination test was negative. There were no abnormal findings in the ear, nose and throat. * Corresponding author: Bakshi Jaimanti MS Department of Otolaryngology and Head Neck Surgery, PGIMER, Chandigarh
Surgical excision was planned via transcervical route under GA. Intraoperative findings revealed 6x6 cm hard mobile swelling adherent rent to upper part of left sternocleidomastoid muscle, left internal juglar vein and left spinal accessory nerve.2x3 cm firm mobile lymph node at left level 2, 1x.5 cm firm mobile lymph node at left level 3 and multiple subcentrimetric lymph nodes in left level 5 were noted and removed. The post operative period was uneventful and there were no signs of recurrence in further follow up till one year. Histopathological findings - The tissue specimen showed poorly circumscribed tumour with tumour cells arranged in whorls and fascicles .The cells were spindle shaped with elongated nuclei, fine chromatin, blunt end with eosinophilic cytoplasm (fig. 3). No increase in mitosis. Focally dilated capillary channels were noted. On immunohistochemistry these cellss were positive for SMA and CD 34(fig. 4a &4b). Thus, the histological diagnosis of leiomyoma was made. Lymph nodes were free of tumour.
Bakshi Jaimanti MS., IJMRI, 2015; Vol. 1(4): 194-196.
DISCUSSION
be achieved by histopathological examination of biopsied tissue.
Leiomyoma is a benign and nonepithelial tumor. These are rare tumours in head and neck and oral cavity.[2] Primary cervical leiomyoma with remarkable calcification and ossification has also been reported which is also a rare entity.[3] When leiomyomas do occur in the head and neck, they are most frequently seen in the oral and nasal cavities and the larynx.[4] Other reports have described leiomyomas of the trachea, thyroid, lateral pterygoid muscle, external auditory canal , tongue, and larynx.
Figure 3 Photomicrograph showing fascicles of spindle cells with cigar shaped nuclei and moderate to abundant eosinophilic cytoplasm. No mitotic figures or pleomorphism is evident. (H&E stain, 400 x magnification)
Figure 1 Clinical picture showingleft leftneck neck swelling swelling at at level level 33 Fig 1 Clinical picture showing
The World Health Organisation classified soft tissue tuomurs into three groups: leiomyoma (solidleiomyoma), angiomyoma (vascular leiomyoma), and epitheloid leiomyoma (bizarre leiomyoma and leiomyoblastoma). Leiomyoma has been the most common and it differs from angiomyoma in degree of angiogenesis.[5]
In our study, histology showed tumour cells arranged in whorls and fascicles. The cells were spindle shaped with elongated nuclei, fine chromatin, blunt end with eosinophilic cytoplasm. No increase in mitosis and on immunohistochemistry cells were positive for SMA. Degree of mitotic activity[8] and posivity for SMA[9] differentiate leiomyoma from leiomyosarcoma.
Figure 4 a Smooth muscle actin (SMA)immunostain highlights diffuse cytoplasmic positivity.
Figure 2 CEMRI neck showing T1 hyper intense mass involving Lt. sternocleidomastoid muscle
The highest prevalence of head and neck leiomyomas is observed in 4th and 5th decades of life. The peak incidence is 40 49 years of age.[6] Our case also falls in the same age group. Higher incidence of this tumour (3.75: 1=F: M) in females could be attributed to hormonal variation s.[7] In recent years, sex steroid receptors (progesterone receptor positive and oestrogen receptor negative on immunohistochemical analysis) have been identified in leiomyomas, which suggest that the growth of these tumors could be hormone dependent. While a diagnosis obtained by fine needle aspiration is ideal prior to surgical excision, definitive diagnosis of leiomyoma can only
Figure 4b CD34 immunostain highlights the tumor vasculature but the tumor cells per se are negative.
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Bakshi Jaimanti MS., IJMRI, 2015; Vol. 1(4): 194-196. Differential diagnosis includes schwannoma, neurofibroma, leiomyosarcoma and fibrous histiocytoma. Management with surgical excision alone is considered adequate. Leiomyoma like other benign lesions has a very good prognosis and very low recurrence rate when completely removed. The malignant transformation of leiomyoma is unlikely. In the largest published series of deep soft tissue leiomyomas (N = 11), Billings et al reported that all 11 patients were alive during a follow up period that ranged from 6 months to 10 years (mean: 42.5 mo).[10] In that series, 1 patient with a positive surgical margin experienced a recurrence at 10 months, and none developed a metastasis. It seems prudent to warn patients of a possibility of recurrence and, followup for at least a year.
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How to cite this article: Bakshi Jaimanti MS et al.,: Sternocleidomastoid Leiomyoma – A Rare Entity, International Journal Of Multidisciplinary Research And Information 2015; 1(4): 194196.
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