Leiomyoma: A rare tumor in the head and neck and oral cavity: Report of 3 cases with review

Abstract

Leiomyomas are benign tumors arising from smooth muscle, most commonly seen in uterine myometrium, gastrointestinal tract, skin and lower extremities of middle-aged women. Leiomyomas are uncommon in the oral cavity with reported incidence of 0.065%, which accounts for 0.42% of all soft-tissue neoplasms in the oral cavity. 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 three cases of leiomyoma comprising of an intraoral vascular leiomyoma and two solid leiomyomas in the head and neck region. The clinical features, etiology, differential diagnosis and treatment of leiomyoma are discussed with review of the literature.

Keywords: Angioleiomyoma; benign; ear auricle; intraoral; leiomyoma; smooth muscle; solid variant.

Figure 1

Clinical picture showing right ear lobe swelling

Figure 2

The cut surface of the excised mass

Figure 3

Photomicrograph showing a well circumscribed lesion having spindle shaped cells arranged in whorls and fascicles with eosinophilic cytoplasm (H&E stain, ×40)

Figure 4

Clinical picture showing two well defined growths on right auricle

Figure 5

Photomicrograph showing spindle cells with indistinct cytoplasm and blunt ended nucleus (H&E stain, ×400)

Figure 6

Photomicrograph showing spindle shaped cells arranged in fascicles with endothelial lined blood vessels (H&Estain, ×40)

Figure 7

Clinical picture showing a palatal swelling

Figure 8

The cut surface of the lesion

Figure 9

Photomicrograph showing plump or spindle shaped cells in a streaming pattern (H&E stain, ×200)

Figure 10

Photomicrograph showing arteries appearing as consumed by the spindle cells (H&E stain, ×200)

Figure 11

Photomicrograph showing the cells with dark blue staining intracytoplasmic fibrils (Mallory's phosphotungstic acid hematoxylin stain, ×400)

Figure 12

Photomicrograph showing smooth muscle fibers arranged in fascicles (pink) admixed with collagen fibers (blue) (Masson trichrome stain, ×100)

Figure 13

Photomicrograph showing smooth muscle cells (pink) in longitudinal and transverse sections with intervening collagen fibers (blue) (Masson trichrome stain, ×200)

Figure 14

Photomicrograph showing smooth muscle cell (pink) with cigar shaped nuclei and a prominent nucleoli admixed with fibrous connective tissue (blue) (Masson trichrome stain, ×400)