Discussion Cutaneous leiomyomas (CL) are benign tumors originating from the erector pilli muscles. They can develop wherever smooth muscle is present. They have equal distribution in both sexes. It has a benign clinical course, and most often presents as multiple cutaneous lesions. Nevertheless, some cases have been described in which single cutaneous leiomyoma appear and even cases in which they appear in families [2-4]. There are reports that associate cutaneous leiomyomatosis to tumors located in other organs, specifically in the uterus and kidneys [5-7]. Pleomorphic adenomas (PA) of the parotid are the most frequently found benign tumors of the major salivary glands  and their simultaneous appearance with CL has been reported. First described by Virchow in 1854 . Cutaneous Leiomyomas (CL), are usually not considered while examining any skin coloured nodule with minimal pain, which is sometimes ignored by the patient and missed by the dermatologist. Cutaneous leiomyoma has received little attention in the recent literature. The histopathological features of Cutaneous Leiomyoma is typical and striking to the eyes which are trained to look for it. Hereditary form causes multiple leiomyomas , noted by Kloepfer et al in 1958 . Malignant transformation probably does not occur.
Three major types of cutaneous leiomyomas exist:
1. Piloleiomyomas, are believed to arise from the errector pili muscle.
2. Angioleiomyomas, originate from smooth muscle (tunica media) within the walls of arteries and veins.
3. Genital leiomyomas.
– They correspond to the histological or anatomic site.
– Menses or pregnancy, temperature and pressure are supposed to be trigger factors for pain [12,13].
– CL are benign tumors that can be exquisitely painful [12,14-16].
– Pathogenesis of pain associated with these lesions is still a mystery.
– The histological findings do not show that prominent nerve fibers are associated with these tumors.
– Others have theorized that specific infiltrating cells may play a role.
– Yet others have suggested that muscle contraction may be pivotal in the induction of pain.
– Genital leiomyomas tend to be the least common of the 3 types.
– Cutaneous leiomyomas with histolopathologic features of uterine symplastic leiomyoma (USL) have also been reported [17,18]. Symplastic leiomyoma is an atypical uterine leiomyoma with cytologic atypia .
– Associated morbidity may be due to spontaneous lesional pain, as well as pain evoked by cold and/or tactile hypersensitivity. Additionally, multiple piloleiomyomas have the potential to be cosmetically disfiguring.
– A racial predilection had not been reported.
– The incidence of piloleiomyomas in men and women appear to be equal.
– Symptomatic lesions often necessitate treatment to alleviate discomfort in affected patients.
– Many options are inadequate or create substantial morbidity.
– The search continues for various methods of treatment like CO2 laser ablation, liquid nitrogen cryo, botulinum toxin, nitrous oxide cryo and enucleation [4,20-23].
– A case of cutaneous leiomyomas (CL) arising in a pleomorphic adenoma (PA) of the parotid gland. PA and CL are benign tumours arising from the parotid gland and the erector pilli muscle, respectively .
– Cutaneous leiomyomas are more likely to occur in adults than in children.
– Isolated reports of cutaneous leiomyomas in children also exist.
– The most common feature in patients with multiple piloleiomyomas is pain [14,24].
1. Erythrocytosis associated with skin leiomyomas [8,25].
– Bilaterally symmetric,
– Linear patterns,
– Piloleiomyomas develop in the superficial dermis, therefore it is fixed to the skin.
– The location of the gene for transmission of dominantly inherited, multiple cutaneous piloleiomyomas associated with uterine leiomyomas in female family members .
– As reported by Alam et al., the locus is named MCUL1 (Multiple Cutaneous and Uterine Leiomyomata) [5,26]. Problem in contemporary pathology is:
– The classification and distinction of spindle cell soft tissue tumours of skin. – Markers such as alpha smooth muscle actin (alpha-SMA) and desmin, considered specific for smooth muscle cell (SMC), have been shown to be expressed in variety of fibroblastic and myofibroblastic processes.
1. Cutaneous Leiomyomas are rare, most of the time not thought of by dermatologists till the histopathology confirms it. Problem in contemporary pathology is the classification and distinction of spindle cell soft tissue tumors of the skin. 2. Markers such as alpha-smooth muscle actin (alpha-SMA) and desmin, considered specific for smooth muscle cell (SMC), have been shown to be expressed in a variety of fibroblastic and myofibroblastic processes. High-molecular-weight caldesmon (h-caldesmon), one of two isoforms, is reported to be expressed exclusively by SMC and shown to be a specific marker of SMC tumors. 3. h-caldesmon is a specific marker of fully differentiated smooth muscle and that it can serve to differentiate spindled SMC soft tissue tumors of the skin from tumors of myofibroblastic and/or fibroblastic origin.
1. Characteristic round, thin-walled vessels and the mixed nature of the tumor cells.
2. There is no cytologic atypia or mitotic activity.
3. Thin spindle cells associated with thin, wavy collagen bundles.
4. Loosely spaced in clear or mucinous matrix.
1. Small groups of fibrils surrounded by rows of palisaded nuclei.
2. Nuclei in two parallel rows enclosing between them a space nearly homogenous anucleate material.
Table I.Neurofibroma vs Neurilemmoma (HP showing Verocay body)
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