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Case Reports
. 2016 Nov 24;2016(11):rjw190.
doi: 10.1093/jscr/rjw190.

Large primary leiomyoma causing progressive cervical deformity

Amro Al-Habib  1 , Essam A Elgamal  2 , Saleh Aldhahri  3 , Riyadh Alokaili  4 , Rami AlShamrani  5 , Abdulaziz Abobotain  5 , Khulood AlRaddadi  5 , Hisham Alkhalidi  6
Affiliations
Case Reports

Large primary leiomyoma causing progressive cervical deformity

Amro Al-Habib et al. J Surg Case Rep. .

Abstract

Leiomyomas are benign smooth tumors that rarely affect the neck area. Complete surgical resection is the treatment of choice. Here, we describe a 13-year-old girl with a large leiomyoma of the neck, which increased in size after incomplete resection. The tumor caused progressive cervical kyphotic deformity, difficulty breathing and severe malnourishment. The tumor was resected successfully in a second surgery, and the patient is stable after 3 years of follow-up. Histopathologically, the tumor was consistent with leiomyoma and showed strong reactivity to specific smooth muscle markers, such as desmin and caldesmon. This is the second reported case demonstrating massive growth of a leiomyoma, with emphasis on complete resection from the beginning.

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Figures

Figure 1:
Figure 1:
Initial axial magnetic resonance image, showing a tumor compressing the spinal cord and encasing the vertebral artery at the C4 level.
Figure 2:
Figure 2:
Histopathologically, the tumor consists of cells resembling normal smooth muscle cells. The cells are uniform, elongated and spindle-shaped, and exhibit a cigar-shaped nucleus (hematoxylin & eosin stain, magnification ×200).
Figure 3:
Figure 3:
Axial magnetic resonance image after the first surgery, showing complete resection of the intraspinal component of the tumor, with a residual tumor and presence of a spinal cord signal at the C4 level.
Figure 4:
Figure 4:
Sagittal (left) and axial (right) T1-weighted contrast-enhanced magnetic resonance images before the second surgery, showed increased size of the extraspinal component of the tumor, with kyphotic deformity of the cervical spine.
Figure 5:
Figure 5:
Sagittal magnetic resonance image 3 years after the second surgery, showing small soft tissue enhancement, suggesting a possible residual tumor, which remained unchanged with follow-up.
Figure 6:
Figure 6:
Immunohistochemical analysis, demonstrating a pattern consistent with leiomyoma. In this example, the tumor cells react strongly to a smooth muscle marker (desmin stain, magnification ×200).
Figure 7:
Figure 7:
The Ki-67 proliferative index of the tumor is low. Only approximately 1% of the nuclei show reactivity (Ki-67 stain, magnification ×200).
See this image and copyright information in PMC

References

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