• Cutaneous leiomyoma (leiomyoma cutis)
  • Arises from the piloerector muscles of skin (arrectores pilorum)
  • Angiomyoma (vascular leiomyoma, angioleiomyoma)
  • Solitary subcutaneous lesion with numerous thick-walled vessels; arise from vessel walls
  • Leiomyoma of deep soft tissue
  • A rare larger deep seated smooth muscle lesion of extremities, abdomen or retroperitoneum


  • Differentiate from leiomyosarcoma


  • Cutaneous lesions
  • Often multifocal, small discrete papules up to 1-2cm, may follow dermatomal distribution
  • Most often involve extensor surfaces
  • May be associated with pain and tenderness, often paroxysmal
  • Usually 15-25 years of age, occasionally younger, even at birth
  • May be familial, ? AD
  • Multiple lesions associated with:
    • Dermatitis herpetiformis; HLA-B8
    • Premature uterine leiomyomas
    • ? erythropoietin
    • MEA Type I
    • Have been associated with HIV
    • Angiomyoma (vascular leiomyoma, angioleiomyoma)
  • Patients generally 30-60 years of age
  • Lower leg most often affected (67%), UE in 22%
  • M:F = 1:1-2
  • 50% with pain ? exacerbation with pressure, temperature change, pregnancy, menses
  • Intraneural location in the median nerve has been reported, dispersing fascicles around the lesion
  • Deep soft tissue lesions


  • Lesions may be calcified
  • MRI
    • hyperintense to skeletal muscle on T1 and hyper- and isointense areas on T2 weighted images
    • Signal voids within the mass in angiomyomas may represent vessels


  • Cutaneous lesions poorly defined, blending in with dermal collagen
  • Angiomyomas are subcutaneous circumbscribed, grayish-white glistening nodules, rarely with Ca++, visibly contract when manipulated, most <2cm in diameter
  • Deep seated lesions are grayish-white small circumscribed tumors which may be gelatinous in nature


  • Masson trichrome and PTAH (phosphotungstic acid-hematoxylin) demonstrates myofibrils
  • EM: myofilaments, surface pinocytotic vesicles, basal laminae
  • Angiomyoma
    • Nodule of smooth muscle fibers swirling away from thick-walled vessels, ? areas of hyalinization, calcification; nerve fibers within capsule and in the lesion
  • Deep seated lesions
  • Intersecting muscle cells ? degenerative changes
  • May have nuclear palisading and perinuclear vaculolization
  • Cytoplasmic glycogen and fuchsinophilia, and longitudinal striations
  • Rarely with "clear cell cytoplasmic changes"
  • + desmin in benign smooth muscle tumors
  • Regressive changes: fibrosis, calcification, and rarely ossification in large lesions
  • Focal calcification may look like psammoma bodies
  • Rarely with nuclear atypia but not mitoses (pleomorphic leiomyoma


  • Hamartomatous deposits of smooth muscle
  • Dermatofibroma (cutaneous fibrous histiocytoma)
  • Nodular fasciitis or myoma when deep seated lesions undergo myxoid changes
  • Clear cell carcinoma or melanoma when with clear cell changes
  • Leiomyosarcoma in deep seated lesions


  • Cutaneous lesions
    • 50% develop recurrences or new cutaneous lesions
  • Nitroglycerin and phenoxybenzamine may be helpful for symptomatic relief
  • Angiomyomas
    • Simple excision resolves pain, rarely recur
    • Malignant transformation has been reported in a LR in a digital location
  • Deep leiomyomas
    • Require complete excision
    • Too rare to determine prognosis
  • Angioleiomyoma has been reported occurring within bone
  • Beware of sampling error missing dx of leiomyosarcoma
  • Two subcategories:
    • Leiomyomas of somatic soft tissue
      • Estrogen and progesterone receptor –
      • No LR or metastasis
      • 1-4 mitoses/50 HPF
    • Retroperitoneal-abdominal leiomyomas
      • F>>M
      • Distinct from the uterus
      • Occasionally multiple
      • Usually estrogen +, always progesterone +
      • 1-10 mitoses/50 HPF
      • LR with + margin has been reported






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