CC BY-NC 4.0 · Arch Plast Surg 2015; 42(01): 98-100
DOI: 10.5999/aps.2015.42.1.98
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Leiomyoma on Nasal Dorsum

Hwan Jun Choi
Department of Pathology, Soonchunhyang Cheonan University Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
,
Kyu Hwa Jung
Department of Pathology, Soonchunhyang Cheonan University Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
,
Jee Hye Lee
Department of Plastic and Reconstrucive Surgery, Soonchunhyang Cheonan University Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
› Author Affiliations
 

Leiomyomas are benign tumor of smooth muscle origin, most commonly found in the uterus and gastrointestinal tract [[1]]. Less than 1% happen in some head and neck structure [[2]]. Especially, they are rare in nose because of paucity of smooth muscle. Almost those cases are usually confined to the subcutaneous tissue and skin, rarely occurring in the deep tissue. We report a 10-year-old female with leiomyoma of the nasal dorsum arising from the deep tissue.

A 10-year-old female was referred to our hospital with a slowly increase in the size of mass for the last 4 years. She has no history of trauma in the years just before the tumor was recognized. Physical examination showed a oval shaped 1.5×1 cm mass on the right nasal side wall, which was non movable and tenderness to palpation ([Fig. 1]). Contrast enhanced computed tomography revealed an oval-shaped nodule that was located in the right nasal dorsum subcutaneous fat layer, most suspected dermoid cyst. It was very close to the nasal bone, but there was no bony erosion and destruction ([Fig. 2]).

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Fig. 1 Preoperative photographic finding shows a 1.5×1 cm sized oval shaped mass on the right nasal lateral wall in a 10-year-old girl.
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Fig. 2 Axial enhanced computed tomography scan shows an oval-shaped nodule that was located in the right nasal dorsum subcutaneous fat layer, close to the nasal bone.

The mass was excised using a direct incision under general anesthesia. In operation, the mass are adhered to the skin, fascia and small vessels. The mass including attached skin was separated from the underlying nasalis muscle. We biopsied the lesion and the pathology report classified it as a leiomyoma with degeneration change in central area, confirmed based on the immunohistochemistry showing desmin negativity and smooth muscle actin positivity ([Fig. 3]). After the resection of the lesion, the patient underwent an observation of 3 months' follow-up, and no recurrence was detected ([Fig. 4]).

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Fig. 3 (A) Microscopic findings shows bundles of smooth muscle cells with collagen fibers with degeneration change in central area (H&E, ×40). (B) Immunohistochemical finding shows positivity for smooth muscle actin (×200).
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Fig. 4 Postoperative 3 months photographic finding reveals removal of the nasal lateral wall mass, no recurrence was detected.

Soft tissue leiomyomas can be subdivided into three distinct groups. The most common form, the cutaneous leiomyoma, arises from the erector pili muscles of the skin and the deep dermis of the scrotum, labia major, and nipple [[3]]. The second group of soft tissue leiomyomas, the angioleiomyomas (also known as angiomyomas or vascular leiomyomas), are differentiated by their subcutaneous location and histology, which is characterized by a conglomeration of thick-walled vessels associated with smooth muscle tissue. These are solitary lesions and most commonly present in the adult, with two thirds occurring in the fourth through sixth decades. These lesions are typically small (<2 cm) and located in the extremities [[3]]. The third group, leiomyomas of the deep soft tissues, may be located in the deep soft tissues of the extremities or the retroperitoneum. The retroperitoneal variety is more commonly found in females, possibly reflecting an origin from hormonally sensitive smooth muscle. Deeper lesions are usually larger, probably because of a delay in detection, and frequently present carried histological alterations, more likely to be confused with leiomyosarcoma [[3]].

Prior to our report, some cases were reported, but almost nasal cavity and paranasal sinus, in the second group. In our case, younger patient has an isolated, nodular soft tissue mass in the external nose that was large enough to approaching the nasal bone imaged with CT. It was a nonvascular leiomyoma originating from deep tissue, with degeneration change.

Among the soft tissue tumors in the head and neck area, 96% area known to be benign, and leiomyomas comprise only 1.3% of them [[4]]. Although there are no malignant degeneration report, the presence of benign areas of leiomyoma within leiomyosarcoma specimens raises such a possibility [[1]]. Recently, immunohistochemistries with mitosis-specific reagent phosphohistone-H3 and Ki-67 were even reported because of the differentiated surgical plan [[5]]. Therefore, leiomyoma must be differentiated from neurofibroma, angiofibroma, schwannoma, myofibroma, leiomyosarcoma, and surgical excision with postoperative histopathologic analysis should be considered.


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Conflict of Interest

No potential conflict of interest relevant to this article was reported.

This work was supported by the Soonchunhyang University Research Fund.


  • References

  • 1 Cizmeci O, Tuncer S, Tuzlali S. Leiomyoma of the nasal dorsum and excision with open rhinoplasty approach. J Plast Reconstr Aesthet Surg 2007; 60: 689-690
  • 2 Campelo VE, Neves MC, Nakanishi M. et al. Nasal cavity vascular leiomyoma: case report and literature review. Braz J Otorhinolaryngol 2008; 74: 147-150
  • 3 Enzinger FM, Weiss SW. In: Benign tumors of smooth muscle. Weiss SW, Goldblum JR. Soft tissue tumors. 4th ed. St. Louis: CV Mosby; 1995: 695-696
  • 4 Kwon JH, Lim SY, Lim HS. Leiomyoma of the forehead. Arch Plast Surg 2013; 40: 165-167
  • 5 Idriss MH, Kazlouskaya V, Malhotra S. et al. Phosphohistone-H3 and Ki-67 immunostaining in cutaneous pilar leiomyoma and leiomyosarcoma (atypical intradermal smooth muscle neoplasm). J Cutan Pathol 2013; 40: 557-563

Correspondence

Hwan Jun Choi
Department of Plastic and Reconstructive Surgery, Soonchunhyang Cheonan University Hospital, Soonchunhyang University College of Medicine
31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 330-721
Korea   
Phone: +82-41-570-2195   
Fax: +82-41-570-6133   

Publication History

Received: 25 March 2014

Accepted: 04 May 2014

Article published online:
05 May 2022

© 2015. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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  • References

  • 1 Cizmeci O, Tuncer S, Tuzlali S. Leiomyoma of the nasal dorsum and excision with open rhinoplasty approach. J Plast Reconstr Aesthet Surg 2007; 60: 689-690
  • 2 Campelo VE, Neves MC, Nakanishi M. et al. Nasal cavity vascular leiomyoma: case report and literature review. Braz J Otorhinolaryngol 2008; 74: 147-150
  • 3 Enzinger FM, Weiss SW. In: Benign tumors of smooth muscle. Weiss SW, Goldblum JR. Soft tissue tumors. 4th ed. St. Louis: CV Mosby; 1995: 695-696
  • 4 Kwon JH, Lim SY, Lim HS. Leiomyoma of the forehead. Arch Plast Surg 2013; 40: 165-167
  • 5 Idriss MH, Kazlouskaya V, Malhotra S. et al. Phosphohistone-H3 and Ki-67 immunostaining in cutaneous pilar leiomyoma and leiomyosarcoma (atypical intradermal smooth muscle neoplasm). J Cutan Pathol 2013; 40: 557-563

Zoom Image
Fig. 1 Preoperative photographic finding shows a 1.5×1 cm sized oval shaped mass on the right nasal lateral wall in a 10-year-old girl.
Zoom Image
Fig. 2 Axial enhanced computed tomography scan shows an oval-shaped nodule that was located in the right nasal dorsum subcutaneous fat layer, close to the nasal bone.
Zoom Image
Fig. 3 (A) Microscopic findings shows bundles of smooth muscle cells with collagen fibers with degeneration change in central area (H&E, ×40). (B) Immunohistochemical finding shows positivity for smooth muscle actin (×200).
Zoom Image
Fig. 4 Postoperative 3 months photographic finding reveals removal of the nasal lateral wall mass, no recurrence was detected.