A rare symplastic or bizarre leiomyoma of the scrotum: a case report and review of the literature
© Masood et al; licensee BioMed Central Ltd. 2008
Received: 13 November 2008
Accepted: 09 December 2008
Published: 09 December 2008
We present a case of a symplastic or "bizarre" leiomyoma of the scrotum. Isolated cases of leiomyomas have been reported arising from the renal pelvis, bladder, spermatic cord, epididymis, prostate as well as the glans penis. However such mesenchymal lesions of the scrotum are very rare.
Macroscopically the tumour was a well-circumscribed grey-white lesion 8.5 cm in size. Because of its peculiar histological characteristics this tumour was assigned as a symplastic or bizarre leiomyoma of the scrotum.
We present this unusual tumour and highlight some important diagnostic and treatment pitfalls related to this rare tumour. This case demonstrates that leiomyomas should be considered in the differential diagnosis of scrotal tumours.
A scrotal ultrasound confirmed normal testes and cord structures but showed a bizarre solid mass with a heterogeneous disorganised pattern with poor vascularity suggesting a mesenchymal tumour arising from the scrotal wall. This mass was excised under a general anaesthetic. The patient made a good recovery post-operatively. Macroscopically the tumour was a well-circumscribed grey-white lesion 8.5 cm in size. Because of its peculiar histological characteristics this tumour was assigned as a symplastic or bizarre leiomyoma of the scrotum.
Conventional leiomyomas may originate from any anatomic location of smooth muscle in the genitourinary system. Isolated cases of leiomyomas have been reported arising from the renal pelvis, bladder, spermatic cord, epididymis, prostate as well as the glans penis [1–4]. However mesenchymal lesions of the scrotum are rare lesions. Leiomyomas are well known to be by far the commonest neoplasm arising from the uterus.
It is important to emphasize that despite their histological characteristics on presentation, compatible with malignancy, these tumours have a benign course not any different from conventional leiomyomas even when they are larger in size than those reported in the literature. In contrast to scrotal leiomyosarcomas, scrotal leiomyomas with bizarre nuclei are not hypercellular, and they lack mitotic activity.
This case report highlights some important diagnostic and treatment issues related to this rare tumour. Histologically they behave differently to both conventional leiomyomas as well as leiomyosarcomas. Their behaviour is benign in nature although it is not clear if they can recur locally. Hence follow-up of these patients is advised. This report highlights the clinicopathological characteristics of the scrotal bizarre leiomyoma in order to increase our understanding, and avoid the possibility of erroneous diagnosis and treatment. It is very important to distinguish these bizarre or symplastic leiomyomas from leiomyosarcomas to avoid unnecessary treatment.
Written consent was obtained from the patient to publish this manuscript and accompanying images. A copy of this consent is available for review by the editor of this journal.
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