10.59987/ads/2011.1-2.9-12
Leiomyoma is a benign smooth muscle tumour, that occurs most frequently in the uterine myometrium, gastrointestinal tract, skin and lower extremities of middle-aged women. Leiomyomas are uncommon in the oral cavity, but in this location are usually localized on the tongue, lips and palate. Most lesions are asymptomatic, although occasional tumours can be painful. The diagnosis is mainly determined by histological studies due to its unspecific clinical appearance. The purpose of this article is to present a case report of 49-year-old male patient with a lesion of the lower lip. After surgical resection hematoxylin-eosin staining confirmed the diagnosis of leiomyoma.
application/pdf
1971-1441
192
1-2
en
M. P. Cristalli 
https://creativecommons.org/licenses/by-nc-nd/4.0
Annali di stomatologia
oral neoplasms
Leiomyoma of oral cavity: case report and literature review
Text.Serial.Journal
https://www.annalidistomatologia.eu/ads
2
Case Report
2022-08-18
2022-08-18
2011-06-01
2023-12-04
9-12
Ann Stomatol (Roma)
M. P. Cristalli 
2011
10.59987/ads/2011.1-2.9-12
9
1971-1441
1-2
oral neoplasms
en
12
Leiomyoma of oral cavity: case report and literature review
https://www.annalidistomatologia.eu/ads/article/download/192/172
2
                                                                                                                 Case report



    Leiomyoma of oral cavity:
    case report and literature review




                                                                                                           li
                                                                                                        na
    Sfasciotti Gianluca, MD, PhD, DDS                             quently it is asymptomatic but there may be symptoms such
    Roberta Marini, DDS                                           as pain, teeth mobility or difficulty in chewing (6,7,8).
    Federica Tonoli, DDS                                          Histologically there are three types of leiomyomas: leiomy-




                                                                                                     io
    Maria Paola Cristalli, DDS, PhD                               oma (solid), angiomyoma (vascular leiomyoma), and the
                                                                  rare form of epitheloid leiomyoma (leioblastoma). In tumours
                                                                  of the solid type blood vessels are large in number but usu-




                                                                              az
    "Sapienza" University of Rome, Rome, Italy                    ally small in size and slit-like. Tumours of the venous type
    Department of Odontostomatological                            have venous blood vessels with thick muscular walls. The
    and Maxillofacial Sciences                                    outer layers of the smooth muscle in the vascular walls
                                                                  blend with intervascular smooth muscle bundles. Tu-
                                                                  mours of the cavernous type are composed of dilated vas-




                                                                            rn
    Corresponding author:                                         cular vessels with small amounts of smooth muscle, and
    Gian Luca Sfasciotti                                          the muscular walls of these vessels are difficult to distin-
    Via Famiano Nardini 1/e                                       guish from smooth muscle bundles (9).
    00162 Rome, Italy                                             From the clinical presentation is very difficult to differen-




                                                                  te
    Ph/Fax +39068610788                                           tiate a leiomyoma from other mesenchymal tumours: the
                                                                  diagnosis is mainly determinate histologically
                                                                  At present, surgical resection is the main treatment of
    Summary
                                                         In       leiomyoma and recurrences are extremely unfrequent.
    Leiomyoma of oral cavity: case report and literature re-      We hereby present a case of leiomyoma, its treatment and
    view.                                                         literature review.

    Leiomyoma is a benign smooth muscle tumour, that
                                                  ni
    occurs most frequently in the uterine myometrium,             Case report
    gastrointestinal tract, skin and lower extremities of
    middle-aged women. Leiomyomas are uncommon in                 A 49-year-old Italian man presented with a 8-year histo-
                                       io

    the oral cavity, but in this location are usually localized   ry of a well circumscribed, asymptomatic and mobile mass
    on the tongue, lips and palate. Most lesions are asymp-       in the lower lip. On macroscopy, the mass presented an
    tomatic, although occasional tumours can be painful.          irregular oval shape, a brownish colour, a smooth surface
    The diagnosis is mainly determined by histological
                             iz



                                                                  and a resilient consistency (Fig. 1).
    studies due to its unspecific clinical appearance.            The mass was surgically excised under local anesthesia
    The purpose of this article is to present a case report of    (mepivacaine 2% with adrenalin 1:100.000 - Carboplyina,
    49-year-old male patient with a lesion of the lower lip.
                                                                  Dentsply) with the scalpel. An elliptic incision was made
             Ed




    After surgical resection hematoxylin-eosin staining con-
                                                                  to fully enucleate the lesion along with the overlying mu-
    firmed the diagnosis of leiomyoma.
                                                                  cosa (Figs. 2,3). It’s important to obtain a complete resection
    Key words: leiomyoma, solid leiomyoma, differential di-       in order to avoid recurrences. Usually easily due to its char-
    agnosis, oral neoplasms.                                      acteristics as a well-circumscribed tumour. Finally, a 5.0-
                                                                  reabsorbable suture (Monocryl - Ethicon) was performed
                                                                  (Fig. 4).
 IC




    Introduction                                                  After surgery, patient was given ibuprofen 600 mg (Brufen
                                                                  600, Abbott) as analgesic and was instructed to apply
    Leiomyoma is a smooth muscle benign tumour that can           chlorhexidine digluconate 0.1% (Corsodyl Gel Dent 30 g
    appear at any location, being the most frequent site the      1g/100) as a gel to the surgical zone.
C




    female genital tract (95%), followed by skin (3%), gas-       The specimens (Fig. 5) obtained were fixed in 10% formalin
    trointestinal and food intrake tract (1,5%). Less than 1%     solution. Histological examination gave the diagnosis of sol-
    occur in head and neck structure (1). Only 0.065% of the      id leiomyoma (Fig. 6).
    leiomyomas had an intraoral location, caused by the lack      The postoperative course of the patient was uneventful with
©




    of smooth muscle at this site (2,3).                          a 10 days follow-up. The tissue is completely healed and
    Smooth muscle is scarce in the oral cavity so it was as-      there is no sign of scar (Fig. 7a). There was no recurrence
    sumed that the formation of leiomyoma resulting from me-      at 24 months follow-up (Fig. 7b).
    dia layer of blood vessels and smooth muscle of excreto-
    ry ducts of salivary glands (4,5).
    Clinically the oral leiomyoma is characterized by a small     Discussion
    (<2cm) and solitary nodular mass, slow growth located prin-
    cipally in the tongue, lips, palate and buccal mucosa: fre-   Oral leiomyomas can appear at any age, but the greatest

    Annali di Stomatologia 2011; II (1-2): 9-12                                                                                9
    G. Sfasciotti et al.




                                                                                               li
                                                                                            na
                                                                                         io
                                                                  az
                                                                rn
                                                      te
                                                      In
    Figure 1 - Clinical presentation of the lesion.   Figure 4 - Suture of the wound.
                                                  ni
                                        io
                              iz
             Ed




    Figure 2 - Surgical excision.                     Figure 5 - Lesion removed.
 IC




                                                      prevalence is in the 40-59 years age groups with gender
                                                      preference for female, being the most frequent locations
C




                                                      the lips, tongue, hard and soft palate, and much less fre-
                                                      quently in the cheeks (10,11): in this case the age is 49
                                                      years old and the site is the lower lip.
                                                      The leiomyoma was included in the World Health Organ-
©




                                                      ization classification of tumors of soft tissue (WHO 2002)
                                                      in the group of tumors arising from smooth muscle. The
                                                      WHO also distinguished three types of leiomyoma: the most
                                                      frequent type is angiomyoma with a 74%, followed by sol-
                                                      id leiomyomas with a 25% and there is only one case of
                                                      an epitheloid leiomyoma described in the literature (12).
                                                      The vascular leiomyoma is the most frequent in the oral
    Figure 3 - Post-surgical view.                    cavity; smooth muscle is scarce in the oral cavity, however

    10                                                                      Annali di Stomatologia 2011; II (1-2): 9-12
    Leiomyoma of oral cavity: case report and literature review


                                                                           as, fibroma, neurofibroma, lipoma, or the leiomyosarcoma.
                                                                           The differential diagnosis is also more problematic with fu-
                                                                           socellular tumours like solitary myofibroma and myoper-
                                                                           icytoma. The differential diagnosis must include salivary
                                                                           gland neoplasms (mucocele, pleomorphic adenoma,
                                                                           etc.), vascular tumors (lymphangioma, hemangioma,




                                                                                                                  li
                                                                           pyogenic granuloma, etc.), and soft tissue cysts such as
                                                                           dermoid cysts. When located in the region of the hard




                                                                                                               na
                                                                           palate, adjacent to teeth the tumor can be confused with
                                                                           a periodontal lesion.
                                                                           Our case had prompted us to assume that the tumor was
                                                                           a hemangioma: macroscopically there were all the char-




                                                                                                            io
                                                                           acteristics of the vascular lesion such as color, tex-
                                                                           ture, absence of pain. Therefore the final diagnosis of oral
                                                                           leiomyoma is mainly determined by a histological study (6-
                                                                           13).




                                                                                       az
    Figure 6 - Histologic findings shows muscle cells with areas of        The exclusive treatment option in benign smooth muscle
    sclerosis and dystrophic calcification; the cells were small and
                                                                           tumours appears to be a surgical excision. Surgery has
    fusiform, and the nucleus was uniform, monochromatic and spin-
    dles, with blunt ends, no mitotic figures were found (Hematoxylin-     been used as the only option for treatment in all leiomy-
    Eosin stain, original magnification x10).                              omas described in literature. There are no reports of re-




                                                                                     rn
                                                                           currence after total excision, and this result confirms the
                                                                           need for careful total excision of the lesion. In our case we
                                                                           did a total resection of the mass under local anaesthesia
    this region is rich in blood vessels. Therefore it has been            and the patient did not present complication and recur-




                                                                          te
    proposed that media layer of blood vessels may be the ori-             rences pathological at two years follow-up.
    gin of oral cavity vascular leiomyoma (6).
    The histological exam of the case report diagnosed that
                                                                In
    the tumour was solid, rare type for the oral site. Solid leiomy-       Conclusion
    omas are smaller than the vascular type and the neofor-
    mation of the case is 0.8 x 0.5 x 0.4 cm. Histologically the           In conclusion, the oral cavity leiomyoma is a benign neo-
    solid leiomyoma is comprised of interlacing bundles of spin-           plasm characterized by a small, solitary, asymptomatic,
    dle-shaped or stellate smooth muscle cells with elongat-               nodular mass, located more frequently in the lower lip. The
                                                  ni
    ed, blunt-ended, pale-staining nuclei: lesions are rather cel-         highest prevalence of head and neck leiomyoma is ob-
    lular, but collagenic strands often separate the streaming             served in the 4th and 5th decade of life with gender pref-
    bundles of tumor cells, and occasional leiomyomas have                 erence for female. Histological features include small
                                       io

    a prominent fibroblastic or myxoid component. All the his-             cells with eosinophilic cytoplasm and basophilic nucle-
    tological characteristic were present in our histological              us. Not mitotic figures, cellular atypia and areas of necro-
    analysis (13).                                                         sis were observed.
    From the clinical appearance is very difficult to differenti-          Oral leiomyoma was frequently asymptomatic and required
                             iz



    ate a leiomyoma from other mesenchymal tumours such                    the complete surgical excision.
             Ed
 IC
C
©




    Figure 7 - Clinical follow-up after 10 days (a) and 24 months (b) from the operation.


    Annali di Stomatologia 2011; II (1-2): 9-12                                                                                      11
    G. Sfasciotti et al.


    References                                                                  ty. Review of the literature and clinicopathologic study of sev-
                                                                                en new cases. Oral Surg 1973;35:54.
     1. Campelo VES, Neves MC, Nakanishi M, Voegels RL. Nasal              8.   Kelly D, Harrigan W. Leiomyoma of the tongue: report of a case.
        cavity vascular leiomyoma: a case report and literature review.         J Oral Surg 1977;35:316.
        Rev. Bras. Otorrinolaringol. 2008;74(1):147-50.                    9.   WHO Pathology and Genetics of Tumours of Soft Tissue and
     2. Farman AG. Benign smooth muscle tumors. S Alf Med J.                    Bone Edited by Christopher D.M. Fletcher, K. Krishnan Unni,




                                                                                                                       li
        1975;49:1333. En: Farman AG, Kay S 1977;43:402.                         Fredrik Mertens (2002) pag. 128-34.
     3. Lloria-Benet M, Bagàn JV, Lloria de Miguel E, Borja-Morant        10.   Luaces Rey R, Lorenzo Franco F, Gomez Oliveira G, Patino




                                                                                                                    na
        A, Alonso S. Oral leiomyoma: a case report. Med Oral.                   Seijas B, Guitiàn D, Lòpez-Cedrùn Cembranos JL. Oral leiomy-
        2003;8(3):215-9.                                                        oma in retro molar trigone. A case report. Med Oral Patol Oral
     4. Stout AP. Solitary cutaneous and subcutaneous leiomyoma.                Cir Bucal. 2007;12(1):E53-5.
        Am J Cancer 1937;29:435.                                          11.   Gonzàlez Sànchez MA, Colorado Bonnin M, Berini Aytès L,
     5. Glas E. Beitrage zur pathologie der zungengrudtumoren. Wein             Gay Escoda C. Leiomyoma of the hard palate: a case report.
        Klin Wochenshr 1905;18:747.                                             Med Oral Patol Oral Cir Bucal. 2007;12(3):E221-4.




                                                                                                                 io
     6. Guitan Cepeda LA, Quezada Rivera D, Rocha FT, Leyva Huer-         12.   Leung K, Wong DY, Li W. Oral leiomyoma: report of a case.
        ta ER, Mendez Sànchez ER. Vascular leiomyoma of the oral                Maxillofac Surg 1990;48:735-8.
        cavity. Clinical, histopathological and immunohistochemical       13.   Baden E, Doyle JL, Lederman DA. Leiomyoma of the oral cav-




                                                                                        az
        characteristics. Presentation of five cases and review of the           ity: a light microscopic and immunohistochemical study with
        literature. Med Oral Patol Oral Cir Bucal. 2008;13(8):E483-8.           review of the literature from 1984 to 1992. Eur J Cancer B Oral
     7. Cherrick H, Dunlap C, King O. Leiomyomas of the oral cavi-              Oncol. 1994 Jan;30B(1):1-7.




                                                                                      rn
                                                                          te
                                                                In
                                                  ni
                                       io
                             iz
             Ed
 IC
C
©




    12                                                                                             Annali di Stomatologia 2011; II (1-2): 9-12
