Upper Cervical Leiomyoma in an Adolescent Male

Abstract

Introduction: Leiomyomas are benign epithelial tumors with a female preponderance usually in the uterus, gastro-intestinal tract and skin. They are well-capsulated tumors with no mitotic activity and little pleomorphism. Primary leiomyoma in the upper cervical spine region is rare and the occurrence of these lesions in young immunocompetent males is extremely rare.

Case report: A 15-year-old male had swelling over the nape of the neck for 4 years with slight difficulty in neck movements for a few months. Asymptomatic 4 years back be developed a painless swelling at the nape of the neck on the right side initially the size of a pea which gradually increased size. A 10x8cm firm, on-tender and non-pulsatile swelling at the nape of the neck on the right extending from the occipital nuchal line and crossing the midline up to the posterior border of the sternomastoid. The skin over the swelling wasn't adherent and the swelling did not reduce on neck movements. Neck movements were terminally restricted with restriction on rotation towards the right. Routine X-ray's and magnetic resonance imaging were suggestive of a soft tissue mass in the inter-muscular plane on the posterior aspect more on the right side with a cystic component and causing thinning of the C2 lamina with no intraspinal extension. Biopsy was done. Findings were suggestive of a spindle cell benign tumor. Posterior en bloc excision was planned and the lesion blog with the entire capsule was excised and sent for histopathology which revealed the lesion was a leiomyoma. The patient has shown no clinical or radiological evidence of recurrence at 4 year fol-low-up.

Conclusion: Leiomyomas in the upper cervical spine is extremely rare in adolescent immunocom-petent male.

Keywords: Leiomyoma; cervical; spine.

Figure 1

Swelling present over the right side of the neck.

Figure 2

Sagittal view of C-spine.

Figure 3

Axial view of soft tissue mass in the inter-muscular plane on posterior aspect more on the right side with a cystic component and thinning of the C2 lamina with no intraspinal extension.

Figure 4

En bloc excision of leiomyoma 10 cm × 8 cm × 4.5 cm.

Figure 5

Proliferation of spindle cells arranged in interlocking bundles in a monotonous pattern of fascicles.

Figure 6

Immunohistochemistry studies showing strong positivity for Desmin.