Primary cutaneous diffuse leiomyosarcoma with desmoplasia

Skin and Cancer Foundation Australia, Darlinghurst, New South Wales, Australia.
Australasian Journal of Dermatology (Impact Factor: 0.98). 12/2006; 47(4):291-5. DOI: 10.1111/j.1440-0960.2006.00298.x
Source: PubMed

ABSTRACT A 65-year-old man presented with an indurated plaque over his left cheek and left neck. An initial punch biopsy of skin showing increased smooth muscle bundles was consistent with a diagnosis of smooth muscle hamartoma. A second incisional skin biopsy revealed a well-differentiated smooth muscle proliferation invading into the dermis and subcutaneous fat in a diffusely infiltrative pattern and with a desmoplastic component, suggesting a diagnosis of desmoplastic leiomyosarcoma. Resection of the tumour confirmed the presence of a cytologically low grade leiomyosarcoma with an insidious infiltrative growth pattern. This rare pattern of diffuse leiomyosarcoma is important to recognize as the histological features are subtle and may potentially constitute a pitfall in histological diagnosis in a small biopsy specimen. In addition, our case illustrates overlapping morphology between diffuse and desmoplastic types of leiomyosarcoma.

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    • "However, in contrast to skin of other sites, it also contains lactiferous ducts that connect to the mammary parenchyma. Table 3 summarizes the clinical features, the treatment and outcome of primary leiomyosarcoma at the nipple-areola complex, the skin of other sites and the mammary parenchyma that reported in literature (Choy et al., 2006; Holst et al., 2002; Lonsdale and Widdison, 1992; Markaki et al., 2003; Uğraş et al., 1997). Tumors of these various sites had similar cytological and architectural characteristics. "
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    ABSTRACT: Malignant and borderline-malignant neoplasms of the dermis can pose diagnostic challenges. Because these tumors can share similar clinical and histologic features, including a predominantly spindle cell morphology, the pathologist must be familiar with these entities in order to facilitate accurate diagnosis, as treatment for these tumors may be different. We review several of these lesions with respect to clinical and histologic features: desmoplastic melanoma, spindle cell carcinoma, spindle cell atypical fibroxanthoma, dermatofibrosarcoma protuberans, and cutaneous leiomyosarcoma.
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