Journal of Cutaneous and Aesthetic Surgery
Print this page
Email this page
Small font size
Default font size
Increase font size
Home About us Current issue Archives Instructions Submission Subscribe Editorial Board Partners Contact e-Alerts Login 


 
   Table of Contents     
CORRESPONDENCE  
Year : 2016  |  Volume : 9  |  Issue : 1  |  Page : 43-45
An unusual presentation of piloleiomyoma


Department of Dermatology, Sri Ramachandra University, Chennai, Tamil Nadu, India

Click here for correspondence address and email

Date of Web Publication11-Mar-2016
 

How to cite this article:
Bubna AK, Veeraraghavan M, Anandan S, Joseph LD. An unusual presentation of piloleiomyoma. J Cutan Aesthet Surg 2016;9:43-5

How to cite this URL:
Bubna AK, Veeraraghavan M, Anandan S, Joseph LD. An unusual presentation of piloleiomyoma. J Cutan Aesthet Surg [serial online] 2016 [cited 2019 Jul 18];9:43-5. Available from: http://www.jcasonline.com/text.asp?2016/9/1/43/178554


Dear Editor,

Piloleiomyomas are benign tumors arising from the arrector pili muscle of hair follicles. They usually present between the second and third decade of life. [1] Predominantly, these tumors are located over the trunk and extremities, range in size between 2 mm to 2 cm, and are painful and firm in consistency. [2]

Our patient was a 45-year-old gentleman who presented to the Department of Dermatology with chief complaints of nodular skin lesions over the left upper arm since the past 7 years. It began as a singular, small pea-sized lesion that gradually progressed to reach the current status. Lesions were asymptomatic, the major cause of concern being cosmetic disfigurement. Clinical examination revealed the presence of around 15 nodules over the left upper arm ranging from 5 cm × 4 cm × 6 cm to 1 cm × 2 cm × 2 cm in size [Figure 1]. They were nontender on palpation and demonstrated a soft-rubbery consistency. A skin biopsy from one of the nodules revealed a normal epidermis, with poorly circumscribed interlacing smooth muscle fibers located in the dermis [Figure 2]. On higher magnification these fibers were individually composed of eosinophilic cytoplasm with an elongated eel-like nuclei [Figure 3]. Immunohistochemistry for smooth muscle actin (SMA) was positive [Figure 4]. However, S100 and Ki67 staining were negative [Figure 5] and [Figure 6]. With these findings a diagnosis of cutaneous leiomyoma was made. The patient was counselled regarding his treatment. However, he declined any surgical intervention.
Figure 1: Fleshy rubbery clustered nodules over the left upper arm

Click here to view
Figure 2: Scanner view of an H&E skin biopsy specimen from one of the nodules showing a normal epidermis with poorly circumscribed interlacing smooth muscle fibers in the dermis

Click here to view
Figure 3: Individual smooth muscle fibers demonstrating an eosinophilic cytoplasm and an elongated eel-like nuclei (H and E 20×)

Click here to view
Figure 4: Immunohistochemistry positive for SMA

Click here to view
Figure 5: Immunohistochemistry negative for S 100

Click here to view
Figure 6: Immunohistochemistry negative for Ki67

Click here to view


Painless piloleiomyoma has not been a commonly encountered entity. A thorough literature search revealed only three case reports manifesting the painless display of piloleiomyoma. [3],[4],[5] Interestingly, in all these three cases piloleiomyoma presented as a solitary nodule, a feature dissimilar to our case, which presented as multiple nodules. Other salient features of the previous three cases including ours have been summarized in [Table 1].
Table 1: Peculiar features of piloleiomyoma in the previous three case reports of painless piloleiomyoma, including ours

Click here to view


With evaluation of our case and study of previous reported cases of painless piloleiomyoma, the authors would like to highlight that the painless quality of these lesions are not only a rarity, but painless leiomyomas are usually accompanied by other atypical findings that need vigilant identification. As far as treatment is concerned, surgical excision is the only available therapeutic modality at present, and given the high recurrence rate after surgery, this line of therapeutic intervention would not be practical with existent multiple nodules. To conclude, further exploration in the emergence of a concrete therapeutic modality in this setting is needed, as this domain still remains vastly unexplored.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Jimena NM, Marcela LM, Carolina LP, Cañadas NG, Castellanos Posse ML, Marchesi C, et al. Atypical leiomyoma: An unusual variant of cutaneous pilar leiomyoma. Dermatol Online J 2009;15:6.  Back to cited text no. 1
    
2.
Raj S, Calonje E, Kraus M, Kavanagh G, Newman PL, Fletcher CD. Cutaneous pilar leiomyoma: Clinicopathologic analysis of 53 lesions in 45 patients. Am J Dermatopathol 1997;19:2-9.  Back to cited text no. 2
    
3.
Pileri A, Ghetti PL, Neri I, Raone B, Ciabatti S, Reggiani C, et al. Atypical piloleiomyoma of the face presenting with central ulceration. Dermatol Reports 2011;3:e50.  Back to cited text no. 3
    
4.
Bhaskar S, Jaiswal AK, Madhu SM, Santosh K. Unusual presentation of cutaneous leiomyoma. Indian J Dermatol 2014;59:634.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Harford RR, Vidmar DA, Cobb MW, Miller ML. An atypical piloleiomyoma presenting as a nonhealing ulcerated nodule. Cutis 1996;57:168-70.  Back to cited text no. 5
    

Top
Correspondence Address:
Aditya Kumar Bubna
Department of Dermatology, Sri Ramachandra University, Porur, Chennai - 600 116, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2077.178554

Rights and Permissions


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed1279    
    Printed11    
    Emailed0    
    PDF Downloaded80    
    Comments [Add]    

Recommend this journal