LEIOMYOMA /prosthodontic courses

LEIOMYOMA
CASE REPORT
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

• Name – Madurappa
• Age – 38 yrs
• Sex – Male
• Occupation – Fruit vender
• Address- No 30 , Banashankari
2nd
stage, Bangalore.

Patient reported with complaint of a swelling
in the upper left side of the face.
The swelling was initially small in size and
slowly increased to the present size and is
Asymptomatic

• Medical ,Dental and Family history –
Not contributory

Habits: Smoker since 10 years, 5-6
cigarettes/ day and alcohol from past 10yrs
occasionally.

On General examination patient was
conscious , co operative, well built and
nourished with normal gait and posture

• Pallor
• Cyanosis
• Icterus No abnormality detected
• Clubbing
• Edema

• Pulse rate – 80 / min
• Blood pressure – 130/80mm of Hg
• Temperature – Afebrile
• Respiratory rate – 16 cycles/ min
• Head – Mesoprosopic
• Face – Asymmetric with convex profile

• Hair
• Nose
• Ears
• Eyes
• TMJ NAD
• Lymph nodes
• Facial and masticatory muscles
• Cranial nerves

• A diffuse ovoid swelling present
over the left side of the mid
face measuring about 3 X 3cm
extending superiorly from the
line joining lateral canthus of
eye to tragus 3cm inferiorly to
the level of corner of the
mouth.
Posteriorly 3cm in front of
tragus and anteriorly around
2cm to the left ala of nose.
• Skin over the swelling appears
normal .

• Inspectory findings confirmed and
On palpation , swelling was firm, tender
with distinct borders and with no rise in
temperature.

• Intra orally, A well defined
swelling present in the upper
left buccal vestibule
extending from mesial aspect
of 26 to the middle of 28
• Mucosa over the swelling
appears normal
• On palpation the swelling was
firm.
• Associated teeth were not
mobile .
• Associated teeth ,25 26 27 28
were vital.

SUMMARY

• Provisional diagnosis- Fibroma
• Differential diagnosis-
Neuroma
Rhabdomyoma
Central giant cell granuloma

• IOPA
• OPG

PNS VEIW
L

• Ultra sound – hypoechoic lesion of left
maxilla
• FNAC – cohesive clusters of spindle and
ovoid cells .
Some cells have cigar shaped nuclei with
blunted ends

• Final diagnosis – Benign spindle cell
tumor possibly a Leiomyoma.

• Excision biopsy – shown a well
encapsulated mass with hypercellularity.
• The cells are spindle shaped and
arranged in long fascicles.
• The cells have eosinophilic cytoplasm with
blunt and cigar shaped nuclei.
• Many blood vessels with thickened walls.

SPECIAL STAINING
• Masson-trichrome stain showed the cells
are of smooth muscle origin .
ANGIOLEIOMYOMA WAS COMFIRMEDwww.indiandentalacademy.com

DISCUSSION
• Leiomyoma is a benign smooth muscle tumor
that may appear in any location of the body.
• VIRCHOW IN 1854.
LEIOS – SMOOTH
MUV - MUSCLE
OMA - TUMOR
• It most commonly occurs in the uterus and in
gastrointestinal tract.
• It occurs rarely in the orofacial region

Incidence – 95% in uterus
- 4-5% in GIT and skin
- 0.065% in oral cavity
( due to the scarcity of the smooth muscle)
GENDER – More common in female ( 2:1)
25% of woman have noticeable fibroids in
their reproductive period.

CLASSIFICATION
• WHO HISTOLOGICALLY CLASSIFIED IN
TO 3 TYPES
1. Leiomyoma ( Solid)
2. Angiomyoma (Vascular leiomyoma)
3. Leiomyoblastoma ( Epithelial leiomyoma)

• Solid leiomyoma – These are well delimited
tumor not associated to the vascular smooth
muscles.
They consists of a network of fusiform cells with
a variable presence of collagen.
• Angioleiomyoma – It arises from vascular
smooth muscles.
• Leiomyoblastoma – It consists of round or
polygonal cells with clear areas surrounding the
nucleus and an acidophillic cytoplasm.

• BASED ON ANATOMIC SITE AND
ORIGIN OF SMOOTH MUSCLE
1. Piloleiomyoma
2. Angioleiomyoma
3. Genital leiomyoma
In piloleiomyoma – Multiple piloleiomyoma
- Solitary piloleiomyoma

PATHOPHYSIOLOGY
• PILOLEIOMYOMA – It may arises either
solitary or multiple lesions, At times
numbering in thousands.
• It arises from the arrector pili muscle ,
which attaches proximally to the hair
follicle and distally to the multiple
attachment points with in the papillary and
reticular dermis as well as to the
basement membrane.

PILOLEIOMYOMA
AGE - Multiple type – 10 to 30 yrs
Solitary type - usually appears later
SEX - Men and Women are equally affected

Clinical features
• The most common feature is pain .
Pain can be spontaneous or induced by cold
or tactile stimuli.
Multiple piloleiomyomas can occur on
Face
Trunk
Extremities with various distribution pattern

MULTIPLE PILOLEIOMYOMA

• Solitary piloleiomyoma is usually found on
lower extremity.
• They are fixed in the skin but they can be
easily moved over the deeper
subcutaneous tissue.
• Individual lesion appear as smooth ,firm
papule or nodule with reddish brown color.
• They are usually smaller than 2cm in
diameter.

HISTOLOGIC FEATURES
• They occur mainly in the reticular dermis
and are non encapsulated.
• The smooth muscle bundles are interlaced
with the variable amount of collagen .
• Occasionally , very low mitotic activity may
be noticed.

Dermal fascicles in low power

ANGIOLEIOMYOMA
SEX- Female:Male 2:1.
AGE- 20 to 60 yrs.

• According to Duhig and Ayer, the vascular
leiomyoma represents only a stage with in a
continuous maturation process of smooth
muscle fibers.
• The maturation process sequence would be as
hemangioma, vascular leiomyoma and to solid
leiomyoma.
• But according to Damm and Neville,
Solid leiomyoma is histologically different from
angioleiomyoma, hence two entities should be
regarded separately.

• These appear as solitary well defined skin
coloured nodules located fairly deep in the
dermis and are frequently smaller than 4
cm.
• Pain is not a prominent feature.
• About 60% of the angiomyomas are
symptomatic.
• Pain in the angiomyoma may be due to
nerve fibers in the stroma or in the wall or
due to the contraction of the muscle fibers.www.indiandentalacademy.com

RADIOGRAPHIC FINDINGS
• Angiomyoma shows charateristic findings
on ultrasound and on MRI.
• On ultrasound images , angioleiomyoma
shows well defined margins and a
homogenous structure suggestive of their
benign nature.
• On colour doppler it shows high resistance
in intratumor arteries suggesting the
presence of muscular arteries.

• On MRI, they show the mixed
hyperintense and isointense areas
compared with the skeletal muscle.
• Capsule appears as hypointense area in
T2 weighted images.

HISTOLOGIC FEATURES
• Well circumscribed and encapsulated
tumor is usually noted in the lower dermis.
• There are interlacing bundles of the
smooth muscle fibers between the
vascular channels .
• Perinuclear vacuolization may be
appreciated in cross section of the muscle
fibers

• The vessel walls display the layers of smooth
muscle fibers and they merge peripherally into
the intervascular muscle fibers.
• The lumen of the vessels may be slit like or
dilated.
• In long standing cases, degenerative changes
like vascular thrombosis, stromal hyalinization,
myxoid changes, dystrophic calcification and
nuclear atypia may present

GENITAL LEIOMYOMA
• It appears as asymptomatic solitary lesion
arising from the dartoic, valuar, or
mamillary muscles in the genital region or
on the nipple.
• Compare to other two types , it has very
low incidence.
• Histologically, it is similar to the
piloleiomyoma.

ORAL LEIOMYOMA
• The leiomyomas are infrequent in the oral cavity.
• They arise from the smooth muscles of the
tunica media or by the embryonic remnants
such as lingual duct or circumvallate papilla.
• The overall incidence of the oral leiomyoma is
0.065%
• They commonly occur in adults.
• males are more frequently affected than females
• The most frequent locations are lip, tongue, hard
and soft palate and cheek.

• The most common type is Angioleiomyoma (60-
69%)
Solid leiomyoma (30%)
Leiomyoblastoma (1.3%)
• They appears as the smooth surfaced
submucosal nodule.
• The colour of the lesion depends upon their
vascularization and depth.
• The 55% of the cases will appear as red, blue,
purple in colour.

• Usually the oral leiomyomas are
asymptomatic.
• Depending upon their size and location,
there may be toothache, loose tooth,
deglutition difficulty, shortness of breath,
referred pain in TMJ etc.

Management- Surgical excision.

References
• Oral surgery,oral medicine, oral pathology
oral radiology and endodontics.2007,
vol 104.
• Journal of oral and maxillofacial
surgery.2001 vol 59.
• Journal of oral pathology.1982 vol 15.
• British journal of oral and maxillofacial
surgery.2002 vol 40.

THANK YOU

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