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A painless, 6-mm scrotal nodule from a 47-year-old man

Deba P Sarma, MD, Omaha

A painless, 6-mm scrotal nodule from a 47-year-old man that has been present for an unknown period of time was biopsied. There

was no history of trauma or previous surgical intervention.

Diagnosis:

Scrotal leiomyoma

Comment:

Ref:

Sarma DP, Santos EE, Hagen GE, Repertinger S. (2009). Scrotal leiomyoma. The Internet J Dermatol 7(1). Indexed by

Google Scholar.

The epidermis is raised due to an eosinophilic dermal soft tissue tumor (Figure 1). The overlying epidermis is essentially normal.The dermal nodule is composed of bundles and fascicles of smooth muscle cells containing red fibrillar cytoplasm and elongated

nuclei with blunted ends (Figure 2). There is no cytologic atypia, increased or atypical mitosis, or necrosis.

Leiomyoma of the scrotum, a benign smooth muscle tumor, may arise from the arrectores pili muscle (piloleiomyoma), vessel wall

(angioleiomyoma), or most commonly from the dartos muscle of the scrotum (genital leiomyoma). Such tumors are quite rare. In

1976, Seigal and Gaffey reviewed the literature and their own cases and uncovered only 11 such cases among a total of 11,000

cases of scrotal tumor 1. Occasional single cases have appeared in the literature since then 2, 3. Scrotal leiomyoma is usually a

single, painless, slow growing tumor occurring in middle-aged men. Simple excision is curative. Leiomyosarcoma, the

malignant counterpart, is even rarer 4. Any cutaneous smooth muscle tumor showing rapid growth, large size, increased cellularity,

cytologic atypia and 2 or more mitoses per 10 high power fields should be considered a leiomyosarcoma 5.

The Internet Journal of Dermatology ISSN: 1531-3018

Scrotal Leiomyoma

Deba P. Sarma MD Department of Pathology, Creighton University Medical Center Omaha, NE USA

http://www.dermpedia.org/files/images/scrotal_fig2.jpghttp://www.dermpedia.org/files/images/scrotal_fig1.jpghttp://www.dermpedia.org/files/images/scrotal_fig2.jpghttp://www.dermpedia.org/files/images/scrotal_fig1.jpg

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Eric E. Santos MD Department of Pathology, St. Margaret's Hospital Spring Valley, IL USA

Catherine E. Hagen BA Department of Pathology, Creighton University Medical Center Omaha, NE USA

Susan Repertinger MD Department of Pathology, Creighton University Medical Center Omaha, NE USA

Citation: D.P. Sarma, E.E. Santos, C.E. Hagen, S. Repertinger: Scrotal Leiomyoma. The Internet Journal of

Dermatology. 2009 Volume 7 Number 1

Keywords: Leiomyoma of skin, smooth muscle tumor of skin, benign scrotal neoplasm

Abstract

A rare case of scrotal leiomyoma occurring in a 47-year-old man is presented.

Case Report

This is a photomicrograph (Figure 1) of a biopsied painless, 6-mm scrotal nodule from a 47-year-

old man that has been present for an unknown period of time. There was no history of trauma or

previous surgical intervention. The epidermis is raised due to an eosinophilic dermal soft tissuetumor. The overlying epidermis is essentially normal. The dermal nodule is composed of bundles

and fascicles of smooth muscle cells containing red fibrillar cytoplasm and elongated nuclei with

blunted ends (Figure2). There is no cytologic atypia, increased or atypical mitosis, or necrosis.

http://www.ispub.com/journal/the-internet-journal-of-dermatology/volume-7-number-1/scrotal-leiomyoma.article-g01.fs.jpg

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Figure 1: Scrotal biopsy, low magnification.

Figure 2: Scrotal biopsy, high magnification

Comment

Leiomyoma of the scrotum, a benign smooth muscle tumor, may arise from the arrectorespilorum muscle (piloleiomyoma), vessel wall (angioleiomyoma), or most commonly from the

dartos muscle of the scrotum (genital leiomyoma). Such tumors are quite rare. In 1976, Seigal

and Gaffey reviewed the literature and their own cases and uncovered only 11 such cases among

a total of 11,000 cases of scrotal tumor [1]. Occasional single cases have appeared in theliterature since then [2,3]. Scrotal leiomyoma is usually a single, painless, slow growing tumor

occurring in middle-aged men. Simple excision is curative. Leiomyosarcoma, the malignantcounterpart, is even rarer [4]. Any cutaneous smooth muscle tumor showing rapid growth, largesize, increased cellularity, cytologic atypia and 2 or more mitoses per 10 high power fields

should be considered a leiomyosarcoma [5].

Correspondence to

Deba P Sarma, MD Department of Pathology Creighton University Medical Center Omaha, NE

68131debasarma@creighton.edu

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1976.

2. Sherwani RK, Rahman K, Akhtar K, Zaheer S, Hassan MJ, Haider A. Leiomyoma of the scrotum. Indian J

Pathol Microbiol. 51(1):72-3, 2008.

3. Ohtake N, Maeda S, Kanzaki T, Shimoinaba K. Leiomyoma of the scrotum. Dermatology. 194(3), 1997.

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4. Moon TD, Sarma DP, Rodriguez FH Jr. Leiomyosarcoma of the scrotum. J Am Acad Dermatol. 20 (2 Pt

1), 1989.

5. Raj S, Caljone E, Kraus M, Kavanagh G, Newman PL, Fletcher CD. Cutaneous pilar leiomyoma:

clinicopathologic analysis of 53 lesions in 45 patients. Am J Dermatopathol. 19:2-9, 1997.