Sonographic Characteristics of Leiomyomatous Tumors of Skin and Nail—A Case Series
Keywords:
leiomyoma cutis; nail leiomyosarcoma; cutaneous leiomyoma ultrasound; leiomyosarcoma nail ultrasound; dermatologic ultrasound; nail ultrasoundAbstract
Introduction - The clinical appearance of the uncommon cutaneous leiomyomatous tumors (LMT) is nonspecific, leading to an extensive differential diagnosis. A non-invasive tool such as high-frequency ultrasound (HFUS) is required for characterizing LMTs in the clinical setting. Although the sonographic features of their uterine counterpart had been well reported, there are only scant reports on the use of ultrasound (US) for studying leiomyomatous neoplasms of the skin and nail.
Objectives and methods – We Characterized common sonographic features of LMT using HFUS in three patients, two of them with multiple cutaneous leiomyomas and another with a subungual leiomyosarcoma.
Results – In all cases, several shared ultrasound (US) characteristics were found. Moreover, we describe a new ultrasonographic sign in cutaneous leiomyomas called the “pine tree” sign, with other features not previously reported.
Conclusion - These ultrasonographic characteristics would strengthen the clinical diagnosis, assist with treatment management, and may help avoid serial biopsies in cases with multiple cutaneous lesions.
References
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9. Wortsman X. Ultrasound of common non-vascular benign cutaneous lesions. In: Wortsman X. ed. Atlas of Dermatologic Ultrasound. 1st ed. Springer NY; 2018:35-82.
10. Wortsman X. Ultrasound of nail conditions. In: Wortsman X. ed. Atlas of Dermatologic Ultrasound. 1st ed. Springer NY; 2018:215-275.
11. Komforti M, Selim MA, Bellet JS. Subungual leiomyoma in the left thumb of a 16-year-old female. J Cutan Pathol. 2016;43(4):379-382. doi:10.1111/cup.12645.
12. Requena L, Baran R. Digital angioleiomyoma: an uncommon neoplasm. J Am Acad Dermatol. 1993;29(6):1043-1044. doi:10.1016/s0190-9622(08)82043-9
13. Watabe D, Sakurai E, Mori S, Akasaka T. Subungual angioleiomyoma. Indian J Dermatol Venereol Leprol. 2017;83(1):74-75. doi:10.4103/0378-6323.185045
14. Wortsman X, Wortsman J. Clinical usefulness of variable-frequency ultrasound in localized lesions of the skin. J Am Acad Dermatol. 2010;62(2):247-256. doi:10.1016/j.jaad.2009.06.016
15. Wortsman X, Alfageme F, Roustan G, et al. Guidelines for Performing Dermatologic Ultrasound Examinations by the DERMUS Group. J Ultrasound Med. 2016;35(3):577-580. doi:10.7863/ultra.15.06046
16. Badeloe S, Frank J. Clinical and molecular genetic aspects of hereditary multiple cutaneous leiomyomatosis. Eur J Dermatol. 2009;19(6):545-551. doi:10.1684/ejd.2009.0749
17. Wortsman X. Sonography of Dermatologic Emergencies. J Ultrasound Med. 2017;36(9):1905-1914. doi:10.1002/jum.14211
18. Dybiec E, Pietrzak A, Bartosińska J, Kieszko R, Kanitakis J. Ultrasound findings in cutaneous sarcoidosis. Postepy Dermatol Alergol. 2015;32(1):51-55. doi:10.5114/pdia.2014.40955
19. Tsai WC, Chiou HJ, Chou YH, Wang HK, Chiou SY, Chang CY. Differentiation between schwannomas and neurofibromas in the extremities and superficial body: the role of high-resolution and color Doppler ultrasonography. J Ultrasound Med. 2008;27(2):161-169. doi:10.7863/jum.2008.27.2.161
20. Lee SJ, Yoon ST. Ultrasonographic and Clinical Characteristics of Schwannoma of the Hand. Clin Orthop Surg. 2017;9(1):91-95. doi:10.4055/cios.2017.9.1.91
21. Wortsman X, Reyes C, Ferreira-Wortsman C, Uribe A, Misad C, Gonzalez S. Sonographic Characteristics of Apocrine Nodular Hidradenoma of the Skin. J Ultrasound Med. 2018;37(3):793-801. doi:10.1002/jum.14379
22. Wortsman X, Wortsman J, Soto R, et al. Benign tumors and pseudotumors of the nail: a novel application of sonography. J Ultrasound Med. 2010;29(5):803-816. doi:10.7863/jum.2010.29.5.803
23. Hanafi M. Ultrasound diagnosis of adenomyosis, leiomyoma, or combined with histopathological correlation. J Hum Reprod Sci. 2013;6(3):189-193. doi:10.4103/0974-1208.121421
24. Miki Y, Abe S, Tokizaki T, Harasawa A, Imamura T, Matsushita T. Imaging characteristics of calcified leiomyoma of deep soft tissue. J Orthop Sci. 2007;12(6):601-605. doi:10.1007/s00776-007-1167-5
25. Stock H, Perino G, Athanasian E, Adler R. Leiomyoma of the foot: sonographic features with pathologic correlation. HSS J. 2011;7(1):94-98. doi:10.1007/s11420-010-9190-z
26. Sardanelli F, Renzetti P, Nardi F, Cittadini G, Tanara G, Simoni G. Imaging of angioleiomyoma. J Clin Ultrasound. 1996;24(5):268-271. doi:10.1002/(SICI)1097-0096(199606)24:5<268::AID-JCU7>3.0.CO;2-C
27. Cigna E, Maruccia M, Malzone G, Malpassini F, Soda G, Drudi FM. A large vascular leiomyoma of the leg. J Ultrasound. 2012;15(2):121-123. doi:10.1016/j.jus.2011.10.007
28. Salemis NS. Recurrent subcutaneous trunk leiomyosarcoma: Management and review of the literature. J Nat Sci Biol Med. 2013;4(1):238-242. doi:10.4103/0976-9668.107316
29. Kacerovska D, Michal M, Kreuzberg B, Mukensnabl P, Kazakov DV. Acral calcified vascular leiomyoma of the skin: a rare clinicopathological variant of cutaneous vascular leiomyomas: report of 3 cases. J Am Acad Dermatol. 2008;59(6):1000-1004. doi:10.1016/j.jaad.2008.07.008
30. Uhara H, Hayashi K, Koga H, Saida T. Multiple hypersonographic spots in basal cell carcinoma. Dermatol Surg. 2007;33(10):1215-1219. doi:10.1111/j.1524-4725.2007.33256.x
31. Walsh JS, Perniciaro C, Randle HW. Calcifying basal cell carcinomas. Dermatol Surg. 1999;25(1):49-51. doi:10.1046/j.1524-4725.1999.08141.x
32. Vega N, Wortsman X, Navarrete N, Sazunic I. Color Doppler Ultrasound Supports Early Diagnosis of Mixed High and Low Risk of Recurrence Subtypes in the Same Basal Cell Carcinoma Lesion. Dermatol Surg. 2018;44(5):741-743. doi:10.1097/DSS.0000000000001328
33. Suster S. Epithelioid leiomyosarcoma of the skin and subcutaneous tissue. Clinicopathologic, immunohistochemical, and ultrastructural study of five cases. Am J Surg Pathol. 1994;18(3):232-240. doi:10.1097/00000478-199403000-00002
34. Zarchi K, Kromann CB, Wortsman X, Jemec GB. Usefulness of ultrasound for the diagnosis of dermatofibroma. Med Ultrason. 2016;18(1):132-133. doi:10.11152/mu.2013.2066.181.kza
2. asendwh MA, Fatani M, Baltow B. Reed's Syndrome: A Case of Multiple Cutaneous Leiomyomas Treated with Liquid Nitrogen Cryotherapy. Case Rep Dermatol. 2016.18;8(1):65-70. doi: 10.1159/000445042.
3. Malik K, Patel P, Chen J, Khachemoune A. Leiomyoma cutis: a focused review on presentation, management, and association with malignancy. Am J Clin Dermatol. 2015;16(1):35-46. doi: 10.1007/s40257-015-0112-1.
4. Ghanadan A, Abbasi A, Kamyab Hesari K. Cutaneous leiomyoma: novel histologic findings for classification and diagnosis. Acta Med Iran. 2013;51(1):19-24. PMID: 23456580.
5. Fields JP, Helwig EB. Leiomyosarcoma of the skin and subcutaneous tissue. Cancer. 1981; 1;47(1):156-69. doi: 10.1002/1097-0142(19810101)47:1<156::aid-cncr2820470127>3.0.co;2-#.
6. Bernstein SC, Roenigk RK. Leiomyosarcoma of the skin. Treatment of 34 cases. Dermatol Surg. 1996 Jul;22(7):631-5. doi: 10.1111/j.1524-4725.1996.tb00609.x.
7. Svarvar C, Böhling T, Berlin O, Gustafson P, Follerås G, Bjerkehagen B, Domanski HA, Sundby Hall K, Tukiainen E, Blomqvist C. Scandinavian Sarcoma Group Leiomyosarcoma Working Group. Clinical course of nonvisceral soft tissue leiomyosarcoma in 225 patients from the Scandinavian Sarcoma Group. Cancer. 2007;109(2):282-91. doi: 10.1002/cncr.22395.
8. Hornick JL, Fletcher CD. Criteria for malignancy in nonvisceral smooth muscle tumors. Ann Diagn Pathol. 2003;7(1):60-66. doi:10.1053/adpa.2003.50010.
9. Wortsman X. Ultrasound of common non-vascular benign cutaneous lesions. In: Wortsman X. ed. Atlas of Dermatologic Ultrasound. 1st ed. Springer NY; 2018:35-82.
10. Wortsman X. Ultrasound of nail conditions. In: Wortsman X. ed. Atlas of Dermatologic Ultrasound. 1st ed. Springer NY; 2018:215-275.
11. Komforti M, Selim MA, Bellet JS. Subungual leiomyoma in the left thumb of a 16-year-old female. J Cutan Pathol. 2016;43(4):379-382. doi:10.1111/cup.12645.
12. Requena L, Baran R. Digital angioleiomyoma: an uncommon neoplasm. J Am Acad Dermatol. 1993;29(6):1043-1044. doi:10.1016/s0190-9622(08)82043-9
13. Watabe D, Sakurai E, Mori S, Akasaka T. Subungual angioleiomyoma. Indian J Dermatol Venereol Leprol. 2017;83(1):74-75. doi:10.4103/0378-6323.185045
14. Wortsman X, Wortsman J. Clinical usefulness of variable-frequency ultrasound in localized lesions of the skin. J Am Acad Dermatol. 2010;62(2):247-256. doi:10.1016/j.jaad.2009.06.016
15. Wortsman X, Alfageme F, Roustan G, et al. Guidelines for Performing Dermatologic Ultrasound Examinations by the DERMUS Group. J Ultrasound Med. 2016;35(3):577-580. doi:10.7863/ultra.15.06046
16. Badeloe S, Frank J. Clinical and molecular genetic aspects of hereditary multiple cutaneous leiomyomatosis. Eur J Dermatol. 2009;19(6):545-551. doi:10.1684/ejd.2009.0749
17. Wortsman X. Sonography of Dermatologic Emergencies. J Ultrasound Med. 2017;36(9):1905-1914. doi:10.1002/jum.14211
18. Dybiec E, Pietrzak A, Bartosińska J, Kieszko R, Kanitakis J. Ultrasound findings in cutaneous sarcoidosis. Postepy Dermatol Alergol. 2015;32(1):51-55. doi:10.5114/pdia.2014.40955
19. Tsai WC, Chiou HJ, Chou YH, Wang HK, Chiou SY, Chang CY. Differentiation between schwannomas and neurofibromas in the extremities and superficial body: the role of high-resolution and color Doppler ultrasonography. J Ultrasound Med. 2008;27(2):161-169. doi:10.7863/jum.2008.27.2.161
20. Lee SJ, Yoon ST. Ultrasonographic and Clinical Characteristics of Schwannoma of the Hand. Clin Orthop Surg. 2017;9(1):91-95. doi:10.4055/cios.2017.9.1.91
21. Wortsman X, Reyes C, Ferreira-Wortsman C, Uribe A, Misad C, Gonzalez S. Sonographic Characteristics of Apocrine Nodular Hidradenoma of the Skin. J Ultrasound Med. 2018;37(3):793-801. doi:10.1002/jum.14379
22. Wortsman X, Wortsman J, Soto R, et al. Benign tumors and pseudotumors of the nail: a novel application of sonography. J Ultrasound Med. 2010;29(5):803-816. doi:10.7863/jum.2010.29.5.803
23. Hanafi M. Ultrasound diagnosis of adenomyosis, leiomyoma, or combined with histopathological correlation. J Hum Reprod Sci. 2013;6(3):189-193. doi:10.4103/0974-1208.121421
24. Miki Y, Abe S, Tokizaki T, Harasawa A, Imamura T, Matsushita T. Imaging characteristics of calcified leiomyoma of deep soft tissue. J Orthop Sci. 2007;12(6):601-605. doi:10.1007/s00776-007-1167-5
25. Stock H, Perino G, Athanasian E, Adler R. Leiomyoma of the foot: sonographic features with pathologic correlation. HSS J. 2011;7(1):94-98. doi:10.1007/s11420-010-9190-z
26. Sardanelli F, Renzetti P, Nardi F, Cittadini G, Tanara G, Simoni G. Imaging of angioleiomyoma. J Clin Ultrasound. 1996;24(5):268-271. doi:10.1002/(SICI)1097-0096(199606)24:5<268::AID-JCU7>3.0.CO;2-C
27. Cigna E, Maruccia M, Malzone G, Malpassini F, Soda G, Drudi FM. A large vascular leiomyoma of the leg. J Ultrasound. 2012;15(2):121-123. doi:10.1016/j.jus.2011.10.007
28. Salemis NS. Recurrent subcutaneous trunk leiomyosarcoma: Management and review of the literature. J Nat Sci Biol Med. 2013;4(1):238-242. doi:10.4103/0976-9668.107316
29. Kacerovska D, Michal M, Kreuzberg B, Mukensnabl P, Kazakov DV. Acral calcified vascular leiomyoma of the skin: a rare clinicopathological variant of cutaneous vascular leiomyomas: report of 3 cases. J Am Acad Dermatol. 2008;59(6):1000-1004. doi:10.1016/j.jaad.2008.07.008
30. Uhara H, Hayashi K, Koga H, Saida T. Multiple hypersonographic spots in basal cell carcinoma. Dermatol Surg. 2007;33(10):1215-1219. doi:10.1111/j.1524-4725.2007.33256.x
31. Walsh JS, Perniciaro C, Randle HW. Calcifying basal cell carcinomas. Dermatol Surg. 1999;25(1):49-51. doi:10.1046/j.1524-4725.1999.08141.x
32. Vega N, Wortsman X, Navarrete N, Sazunic I. Color Doppler Ultrasound Supports Early Diagnosis of Mixed High and Low Risk of Recurrence Subtypes in the Same Basal Cell Carcinoma Lesion. Dermatol Surg. 2018;44(5):741-743. doi:10.1097/DSS.0000000000001328
33. Suster S. Epithelioid leiomyosarcoma of the skin and subcutaneous tissue. Clinicopathologic, immunohistochemical, and ultrastructural study of five cases. Am J Surg Pathol. 1994;18(3):232-240. doi:10.1097/00000478-199403000-00002
34. Zarchi K, Kromann CB, Wortsman X, Jemec GB. Usefulness of ultrasound for the diagnosis of dermatofibroma. Med Ultrason. 2016;18(1):132-133. doi:10.11152/mu.2013.2066.181.kza
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2022-07-28
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Copyright (c) 2022 eyal taleb, Cristobal Saldias, Sergio Gonzalez, carlos Misad, Ximena Wortsman
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Taleb E, Saldias C, Gonzalez S, Misad C, Wortsman X. Sonographic Characteristics of Leiomyomatous Tumors of Skin and Nail—A Case Series. Dermatol Pract Concept. 2022;12(3). doi:10.5826/dpc.1203a82
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