| Abstract|| |
Leiomyoma is a benign smooth muscle cell tumor commonly occurring in the uterine myometrium. Extra-uterine tumors are infrequent and those occurring in an intracranial location are extremely rare. We report a primary intracranial leiomyoma as an incidental autopsy finding in a 60-year-old woman, who died of acute myocardial infarction.
Keywords: Dural-based, extra-uterine, intracranial, leiomyoma
|How to cite this article:|
Zare P, Vaideeswar P. Incidental dural-based mass: Surprisingly leiomyoma. Indian J Pathol Microbiol 2021;64:837-8
| Case Report|| |
A 60-year-old post-menopausal immunocompetent woman, with a history of acute-onset chest pain, developed cardiogenic shock secondary to acute myocardial infarction with chordal rupture and severe acute mitral regurgitation. However, the patient could not be salvaged and she expired within 45 min of ward stay. A complete clinical autopsy was requested.
As per the autopsy protocol, representative samples from the organs had been preserved for histopathology examination in a suitable container. At the time of taking sections for histopathology, a dural-based marble-sized (3 cm in diameter) smooth-surfaced (except at the site of attachment) mass was discovered [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d. It was very firm in consistency with a gray-white to pale brown focally fasciculated cut surface [Figure 1]e. On histology, the mass was composed of interlacing fascicles of spindle-shaped cells with extensive hyalinization [Figure 2]a, [Figure 2]b, [Figure 2]c, [Figure 2]d. The cells had elongated vesicular nuclei and finely granular cytoplasm with indistinct cell margins. No atypia, mitosis, or necrosis was observed. The tumor cells displayed positive staining for smooth muscle actin on immunohistochemistry [Figure 2]d. A diagnosis of primary intracranial leiomyoma (PIL) was made. After this diagnosis, the photographs taken during autopsy were reviewed. The base of the brain in the right frontal lobe showed a distinct depression, which would have corresponded to the dural-based leiomyoma. The cause of death was related to acute myocardial infarction associated with infarction of the posterior papillary muscle as well; chordal rupture was not present. The aortic valve was bicuspid. The lungs were edematous. Other organs showed no pathological findings.
|Figure 1: (a) Marble-sized mass hidden by the dural folds; (b) The dura was incised to reveal the tumor in totality; (c) The non-dural surface was smooth; (d) Tags of fibrous tissue indicating the site of attachment; (e) The cut surface reveals pale brown color with fine fasciculations|
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|Figure 2: Intracranial leiomyoma showed paucicellular hyalinized areas (a) (H and E ×200) and (b) (H and E ×400) and intersecting cellular areas (c) (H and E ×200) and (d) (H and E ×400); Immunohistochemical positivity for smooth muscle actin (x400) (e) Review of the photograph of the base of the brain revealed depression (arrow) in the right frontal region|
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| Discussion|| |
Intracranial benign mesenchymal neoplasms are rare entities and include all such tumors usually seen in the soft tissue or bones. Although extra-uterine leiomyomas have been reported in almost every organ in the body, PILs are exceedingly uncommon. The first case, reported by Kroe et al. in 1968, was intra-sellar and presumed to be arising from embryonic rests, pluripotent mesenchymal cells, peri-vascular connective tissue, leptomeninges or smooth muscle cells of the blood vessels. PILs have been documented as dural-based or intra-parenchymal masses (cerebral hemispheres, basal ganglia and lateral ventricles).
A total of 33 cases of PIL have been reported so far. The average age of incidence observed was 36 years; youngest patient was 4 years old and oldest, 68 years. Nineteen (57.5%) of 33 cases were women, suggesting a female predominance. Dural-based tumors were observed in 13 patients (seven men and six women), 2 of which were closely associated with the cavernous sinus. All patients were symptomatic, presenting with complaints related to raised intracranial pressure or effects of compression; some symptoms were even constitutional. Additionally, 7 patients were either immunocompromised or immunosuppressed; rest were immunocompetent. Our patient was immunocompetent and asymptomatic despite the supra-tentorial PIL. There have been few reports of benign metastasizing uterine leiomyoma. We excluded this possibility as uterus was atrophic at autopsy. Though rare, leiomyoma should be considered in the differential diagnosis of a well-circumscribed intracranial lesion and the rarity of this tumor should not lead to a misdiagnosis.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
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Department of Pathology (Cardiovascular and Thoracic Division), Seth GS Medical College, Maharashtra
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]