Skin leiomyoma is a benign tumor. Leiomyoma. Leiomyomas from the muscles that raise the hair. Angioleiomyoma Epithelioid leiomyoma under the skin in a large vessel

(leiomyoma cutis)

Synonyms: angioleiomyoma.

The first description of leiomyoma belongs to R. Virchow (1854), who subjected to histological examination of tumors that appeared on the skin of the chest in a 32-year-old man. Later, Besnier (1873, 1880) and Babes (1884) proposed a classification of skin leiomyomas, highlighting vascular leiomyoma.

Currently, according to histogenesis, 3 types of skin leiomyomas are distinguished, characterized by clinical and histomorphological features characteristic of each of them.

Type I - multiple leiomyomas that develop from smooth muscle, levator hair, or diagonal muscles.
.II type - dartoid (genital) solitary leiomyomas developing from tunica dartos of the scrotum and smooth muscles of the pectoral nipples
.Ill type - solitary angioleiomyomas developing from the muscular walls of the trailing arteries and smooth muscle elements of the walls of small vessels

Some authors believe that leiomyoma and angioleiomyoma are more likely a malformation than neoplasm in the full sense of the word. There are single descriptions of familial leiomyoma, which allows us to consider this disease as genetically determined.

Clinic

Multiple leiomyomas of the skin occur in men almost twice as often as in women; Angioleiomyomas, on the other hand, are more common in women.

Leiomyomas from the muscles that raise the hair, as a rule, are characterized by multicentric growth, that is, they are multiple. These are dense raised nodules of regular shape, stagnant red, brownish, bluish-reddish in color, ranging in size from a pinhead to lentils, large beans and more. The surface of the nodules is smooth, shiny. They are localized on the trunk and limbs, more often arranged in groups.

A characteristic feature of skin leiomyomas is the appearance or intensification of pain under the influence of mechanical irritation (rubbing with clothes, scratching, pressure or touch) and cooling, as well as spontaneous attacks of severe unbearable pain lasting several minutes, often accompanied by dilated pupils, decreased blood pressure, skin blanching. compression nerve cells leiomyoma can cause pain. Some authors note a slow worm-like contraction of the nodules in the cold.

Angioleiomyoma, according to many authors, develops from the muscle elements of small vessels of the skin. Clinically, these are solitary, but often diffusely widespread or locally multiple formations in the form of dense nodules, tumors, slightly rising above the skin surface. The tumor is painful on pressure, but less so than in leiomyomas. Often, angioleiomyoma is located near large joints.

The age of the patients is middle and old.

Genital leiomyoma (tunica dartos leiomyoma) is rare. It is localized more often on the scrotum, labia majora, less often on the nipples and is characterized by single dense tumor-like formations of a brownish-red color, up to 1.5-3 cm in diameter.

May contract worm-like when exposed to cold or friction. Leiomyoma of the scrotum can develop from isolated individual muscle cells dermis, histologically resembling myofibroblasts. With rare exceptions, all of these tumors are benign.

Histopathology

Leiomyoma consists of intertwining bundles of smooth muscle fibers with moderate connective tissue layers: they usually have few vessels, but many nerve fibers(Torsuev, 1940; Stout, 1953; etc.).

Angioleiomyoma is located deep in the dermis and in subcutaneous tissue; consists of intertwining thin and short muscle fibers; nuclei of muscle cells are oval, spindle-shaped, hyperchromic. There is an abundance of blood vessels among the muscle fibers (Apatenko A. K, 1963)

Differential Diagnosis

Differential diagnosis should be made with fibromas, angiomas, fibrosarcomas, neurofibromas, Kaposi's angioreticulosis (sarcoma), epitheliomas, skin leiomyosarcomas and other tumors.

Skin leiomyoma - benign tumor, which develops from the smooth muscle elements of the skin. It occurs more often in men in young and middle age.

Synonym skin leiomyomas: dermatomyoma.

Allocate:

multiple leiomyomas of the skin, the number of which sometimes reaches several hundred, developing from the smooth muscles of the skin;
solitary, or dartoid, leiomyomas of the skin of the genital organs and smooth muscles of the nipple of the mammary gland;
vascular leiomyomas, developing from the muscular membrane of the vessels of the skin.

pathological anatomy

At pathological anatomical examination, skin leiomyomas have the form of nodules and nodules of pinkish color, 1-3 cm in diameter (dartoid leiomyomas can reach 4-5 cm in diameter). Multiple and small-vessel leiomyomas are more likely to affect the skin upper limbs; leiomyomas originating from the trailing arteries - the skin lower extremities with a favorite localization in the area of the joints of the lower leg and foot.

Microscopic examination shows that skin leiomyomas are built from bundles of smooth muscle fibers that intertwine in different directions. In dartoid tumors, muscle fibers are thickened, separated by uneven layers fibrous tissue containing small vessels. For vascular leiomyomas of the skin, it is characteristic a large number of vessels of various sizes, resembling arteries and veins, or small vessels in the form of slits with indistinct muscular walls, directly passing into the tumor tissue.

Clinical manifestations

The clinical picture is characterized by pain on palpation and sensitivity of the tumor to a decrease in ambient temperature.

Diagnostics

The diagnosis is made on the basis of clinical and pathological findings.

Treatment

Treatment of skin leiomyoma is excision of the tumor within healthy tissues.

Forecast

The prognosis for skin leiomyoma is favorable. Relapses after surgery are extremely rare.

Big medical encyclopedia 1979

Leiomyoma of the skin is a tumor neoplasm arising from smooth muscle cells. In rare cases, leiomyoma becomes malignant. The disease develops more often in men.

Reasons for the development of the disease

The exact causes of leiomyoma development are currently unknown. There is an opinion that this disease is associated with a malformation and is not a neoplasm (newly formed tissue). Cases of familial leiomyoma are described, that is, the hereditary factor plays an important role in the development of the disease.

Forms of the disease

Depending on histogenesis, three types of cutaneous leiomyomas are distinguished:

First type. These are multiple tumors that develop from levator hairis smooth muscles or from diagonal muscles.
The second type of disease is genital leiomyomas. These are, as a rule, solitary tumors that develop from the smooth muscle fibers of the scrotum or nipples of the breast.
The third type of disease (angioleiomyoma) develops from the smooth muscle fibers of the vessel walls.

Clinical picture

Rubbing clothes on neoplasms is accompanied by pain.

The main symptom of skin leiomyoma is the appearance of a spherical dense nodule. The size of the nodule can vary from the size of a millet grain to walnut. The color of the neoplasm in leiomyoma is reddish, brown or cyanotic.

Feature leiomyomas - neoplasms are sharply painful when exposed to them (combing, rubbing with clothes, squeezing, etc.). Pain occurs due to compression of the nerve endings by the tumor.

Intense pain in leiomyoma may be accompanied by such common reactions like decreased blood pressure, pupillary constriction, skin pallor.

Clinical manifestations of type 1 disease

Skin leiomyomas of the first type are usually multiple. Tumors are located on the neck, face, skin of the trunk and extremities. Tumors often form in clusters.

Histological examination of leiomyoma reveals a complex interlacing of smooth muscle fibers. The bundles are separated by layers of connective tissue. The cell nuclei are hyperchromic, the number of nerve fibers is increased, and the number blood vessels, on the contrary, is reduced.

The tumor in type 1 leiomyoma is clearly limited from the surrounding dermal tissues. Surrounding tissues may show slight swelling and signs dystrophic changes.

Clinical manifestations of the second type of disease

Genital leiomyoma is a single brown-red nodule the size of a large cherry. The tumor is usually painless. The histological picture is similar to type 1 leiomyoma.

Clinical manifestations of the third type of disease

Angioleiomyoma is a solitary tumor, slightly protruding above the surface of the skin. The skin over the tumor can be either unchanged or red-cyanotic. On palpation of the neoplasm, pain is felt.

In a small area, several separate tumor elements may form. Angioleiomyoma is localized, most often on the limbs, near the joints.

Angioleiomyoma has a specific histological picture. The neoplasm consists of a complex weave of thin and short bundles of muscle fibers, which can be arranged randomly or in the form of concentric eddies. In the tissues of the tumor, many cells with elongated nuclei are observed.

There are many vessels in the tissues, the membrane of which directly passes into the tumor. In this regard, the lumen of the vessels has the form of a gap.

Diagnostic methods

Diagnosis of leiomyoma is carried out by examining clinical picture. To confirm the diagnosis, it is necessary to histological examination.

It is necessary to differentiate leiomyoma from glomus tumor, and other tumor pathologies of the skin. To do this, conduct a cold test, leiomyoma after exposure to cold is temporarily reduced in size. At mechanical action on the skin covering the leiomyoma, a " goose pimples».

Treatment

For treatment, a surgical method is used.

Used to treat leiomyoma radical methods- surgical excision or removal of the tumor by coagulation.

Surgical excision is used for large sizes leiomyomas. The operation is performed under local anesthesia, after its behavior, a small scar remains on the skin.

Thermo- and diathermocoagulation. When using these methods, the tumor is destroyed by exposure to high temperature through the impact electric current. The method is bloodless, after its application a pigmented spot or a small scar remains.

Laser destruction. When using this method, the tumor is destroyed under the action of a laser beam, that is, under the action of light. Such surgeries are generally well tolerated by patients.

Cryodestruction using liquid nitrogen. The tumor is destroyed under the influence of cold. This treatment is effective for initial stages cutaneous leiomyoma.

With multiple leiomyomas for removal pain syndrome drugs can be prescribed - calcium antagonists - Verapomil, Nifedipine, Diltiazem.

Treatment with folk methods

Most effective treatment Leiomyomas are surgical removal. But if the operation is not carried out for some reason, it is possible to use folk remedies.

Celandine ointment for the treatment of leiomyoma. It is necessary to take a whole plant (with roots and leaves) and squeeze the juice out of it. For one part of juice, take four parts of petroleum jelly or baby cream. Mix well. Apply to the tumor twice a day.

Compresses from the juice of the golden mustache. In the treatment of leiomyoma, the golden mustache plant can help. From the stems and leaves, juice should be prepared and used for compresses on the tumor. Bandages should be changed once a day.

Treatment of leiomyoma with plantain. It is necessary to collect sheets of plantain, knead them and attach to the tumor. Fix the compress with a bandage. In winter, when it is difficult to get fresh plantain, you can cook steam from dry grass. The leaves steamed in boiling water should be put on a piece of bandage and applied to the tumor with leiomyoma. Keep the compress for a day, then you should prepare a new one. For treatment, plantain should be used, growing at a distance from the roads.

For oral administration in the treatment of leiomyoma, it is recommended to prepare beetroot juice. Freshly prepared juice should be placed in the refrigerator for at least three hours. After that, treatment for leiomyoma can begin. You should drink 500 ml of juice per day, dividing this amount into 10 servings.

Forecast and prevention

Prevention of leiomyoma development has not been developed. the only possible measure- Close monitoring of the condition skin and immediate medical attention in case of appearance of tumor-like formations.

The prognosis for solitary leiomyomas is favorable, with multiple tumors- relatively favorable. Sometimes a leiomyoma takes on a malignant character, degenerating into leiomyosarcoma.

Leiomyoma is a benign tumor originating from mutated smooth muscle cells. In most cases, these neoplasms do not transform into a cancerous lesion.

Etiology of the disease

Recent Scientific research proved the existence of dominantly transmitted genes and female genital organs. Based on this theory, among members of the same family, there is genetic predisposition to this oncology.

Leiomyoma symptoms

A common symptom of leiomyoma lesions is pain syndrome, which has the following characteristics:

pain can be spontaneous or provoked by mechanical and tactile stimuli;
painful sensations are primary and secondary in relation to pressure on the nerve endings of the tumor;
Genital leiomyomas are usually asymptomatic, which significantly complicates early diagnosis diseases.

Leiomyoma lesions of the uterus in women are accompanied by irregular menstrual cycle and occasional uterine bleeding.

Leiomyoma - photo:

Leiomyoma: types and description

Depending on the location of the tumor relative to muscle fibers, leiomyomas are usually divided into the following classes:

Intramural myoma:

A benign neoplasm is located within the muscle fibers. This is the most commonly diagnosed form of leiomyoma.

submucosal fibroids:

Mutated tissues affect the mucosal layer and can spread into the lumen of the organ.

Subserous myoma:

The tumor is localized in the outer layer of the muscle wall.

Modern diagnostics of leiomyoma

In the process of examining a myoma lesion, the doctor, after a visual examination, prescribes the delivery of a general and detailed blood test. Laboratory research studies hemoglobin and hematocrit.

Additional diagnostic techniques include:

Ultrasound examination:

With uterine leiomyoma, it is practically the only way establishing a diagnosis. Using this technique, the doctor can assess the size and localization of a benign neoplasm.

Magnetic resonance imaging:

X-ray scanning of the affected area of the body determines the presence of a tumor. At the same time, radiology does not provide information about the structure and tissue affiliation of the tumor process.

Biopsy:

Histological and cytological analysis a small area of pathology establishes the final diagnosis indicating the stage and extent of leiomyoma.

Methods of treatment and removal of leiomyomas

Therapy of leiomyoma lesions consists in the use of medication and surgical methods impact on the tumor.

Medical treatment

A conservative method of treatment includes the use of the following drugs:

1. Blockers calcium channels:

Medical studies indicate that these funds, in particular "Nifedipine", contribute to the relief of pain. The mechanism of the analgesic effect is achieved by inhibiting the movement of extracellular calcium ions, which stimulate muscle contraction. This effect of calcium channel blockers confirms the theory of the secondary occurrence of pain in muscle fiber leiomyoma.

2.Alpha-adrenergic receptor inhibitors:

These drugs relieve pain attacks during the action of tactile stimuli.

Surgery to remove leiomyoma

Today's radical intervention is key method therapy for this tumor. Surgery is indicated for all types of leiomyoma and provides for the complete excision of mutated tissues. Removal of the tumor, as a rule, occurs in conjunction with resection of the uterus. In modern oncology clinics surgical intervention performed using laparoscopic technique. This operation has a number of advantages over traditional excision of pathology. Laparoscopy can significantly reduce rehabilitation period, which is achieved by low invasiveness of the operation.

The surgical technology for removing leiomyomas should include ablation of pathological blood vessels. The essence of the method is intravenous administration catheter that supplies a special drug into cancer cells. The toxic effect of such agents leads to the destruction vascular network neoplasms. Depriving the tumor of nutrition causes the disintegration of the fibroids. Often, the method of ablation of blood vessels is combined with a conservative method.

Chemotherapy

The use of cytotoxic drugs is justified only in the malignant course of fibroids. In such cases, chemotherapy is dosed in accordance with the general somatic condition of the cancer patient. In most cases, the amount of chemotherapeutic agents is calculated individually for each patient.

Leiomyoma: prognosis

Since leiomyoma is considered a benign neoplasm, the prognosis of the disease is favorable. Postoperative survival of patients is in the range of 95-100%. Surgical intervention in this case requires follow-up monitoring, which lasts one year. During this period, patients need to undergo preventive examination to prevent recurrence of the disease.

How many people live with this disease?

muscle fibers after surgical intervention practically does not change the quality of life of the patient.

The exception is inoperable and malignant species fibroids. In such cases, the five-year survival rate for cancer patients averages 50%. The prognosis of the disease in this case is determined by the presence of secondary foci of oncology, which are localized in distant organs and systems.

Leiomyoma, like all oncological diseases, requires timely diagnosis and, accordingly, adequate treatment. Only timely removed myoma has a favorable outcome of general therapy.

leiomyoma

Leiomyoma (leiomyoma; from Greek leios - smooth and mys, myos - muscle) is a benign tumor originating from smooth muscle fibers.

Leiomyomas can occur in all organs where there are smooth muscle fibers, but they are more common in the uterus, in digestive tract, bladder, prostate and skin. By their origin, leiomyoma of the skin, esophagus, intestines are considered as dysontogenetic formations, L. of the uterus - as a consequence of endocrine disorders.

Tumor round shape, clearly delimited from the surrounding tissues; its consistency is dense, especially with a high content of connective tissue (leiomyofibroma). L.'s nodes are often multiple, sizes vary from microscopic to the diameter of the head of a full-term fetus and more; on the cut - pinkish, gray white with a peculiar layered pattern due to the intersection of differently located muscle bundles. Microscopically, leiomyomas are built from muscle fibers that are somewhat larger than normal ones. Tumor cell nuclei are also relatively larger and richer in chromatin. In L., muscle fibers form randomly located bundles, and around the vessels they are sometimes placed concentrically, in the form of clutches. Vessels are usually few; they are thin-walled, with a narrow lumen; rarely L. contain a large number of dilated vessels (cavernous L.).

In long-term leiomyomas, as a result of circulatory disorders, dystrophic and atrophic changes in muscle fibers can be observed with their replacement connective tissue; the latter can be subjected to hyalinosis, petrification, less often ossification. In addition, foci of necrosis, hemorrhages with the formation of cysts can occur in leiomyomas. L.'s malignancy is possible (see Leiomyosarcoma). The treatment is surgical, the prognosis is favorable.

skin leiomyoma(synonym: myoma cutis, dermatomyoma) - as a rule, a benign skin tumor originating from a smooth muscle tissue. There are single leiomyomas of the skin, single L. of the genital organs (these L. have some structural features) and multiple L. of the skin. Histologically, for all L. of the skin, interlacing of bundles of smooth muscle fibers with bundles of collagen tissue is characteristic.

Solitary skin leiomyomas (synonymous with solitary angioleiomyomas) are formed from the smooth muscles of the venous wall, they are nodes that usually do not exceed 1 cm, less often 1.5 cm in diameter. They are located in the thickness of the dermis, protrude above the surrounding skin in the form of oval or rounded pinkish-yellow tumors, sometimes with a brown tint. The boundaries are clear (tumors are encapsulated), the consistency is dense. Quite often tumors are penetrated by blood vessels. On the skin of the face and extremities, more often the upper ones, groups of mobile tumors that are not interconnected can be observed. On palpation, there is a sharp soreness, but it can also occur spontaneously. Paroxysmal pains develop suddenly and also suddenly disappear after 1.5-2 hours. Pain and "tension" of the tumor may be aggravated by cold.

Single leiomyomas of the genital organs can develop on the scrotum, labia majora, in the area of the nipples of the mammary glands. These tumors are pinkish-yellowish in color, up to hazelnut, usually unstressed.

Multiple L. of the skin - no more than 0.5-0.7 cm in diameter, often tense, can be disseminated and in groups, often combined with uterine fibroids. Cases of disease of several members of the family, as well as the development of multiple L. skin at the site of injury are described.

Single L. of the genital organs and multiple L. of the skin are not encapsulated; the number of blood vessels in them is small, the amount of collagen is usually very significant; located in the dermis.

The course of skin leiomyoma is long, the prognosis is favorable, malignant degeneration is extremely rare. Treatment: surgical, electrocoagulation, application of carbonic acid snow.