Leiomyomas in a naevoid distribution

Binod K Khaitan, Apra Sood, Arun Joshi, AK Bajaj, Taru Garg, MK Singh

 Department of Dermatology & Venereology and Department of Pathology, All India Institute of Medical Sciences, New Delhi -110 029, India

Correspondence Address:
Binod K Khaitan
Department of Dermatology & Venereology, All India Institute of Medical Sciences, New Delhi -110 029
India

Introduction

Leiomyomas are rare benign cutaneous tumours which may be solitary or multiple. Multiple leiomyomas usually involve more than one region of the body.[1] We report a rare case of multiple leiomyomas in a naevoid distribution.

Case Report

A 59 -year-old man presented with multiple erythematous papules and nodules on the trunk, since 10 years. In the initial period some new lesions kept appearing and the older lesions were gradually increasing in size. However, there was no progression in the later years. These papulonodules were present in a broad S-shaped band extending from the midline below the sternum across the left side of the trunk to the midline on the back [Figure - 1]. They were irregular or hemispherical in shape with a smooth surface, firm in consistency and extremely tender. The patient also experienced spasms of pain in the larger lesions on exposure to cold. There was no other skin or mucous membrane lesion. No other family member had similar lesions. A diagnosis of pilar leiomyomas in a naevoid distribution was made. A biopsy from the nodule showed interlacing smooth muscle bundles in the upper and mid dermis [Figure - 2] suggestive of a leiomyoma.

Discussion

Leiomyomas derived from the arrector pill muscle (piloleiomyomas) are often multiple than solitary. The onset is in the second or third decade of life. They usually appear as reddish brown papulo-nodules and patients may develop several hundred lesions. The disease may be inherited in an autosomal dominantfashion or may be non-hereditary.[2]

Multiple cutaneous leiomyomas are more often bilateral and seen more frequently on the extremities. A majority of the patients have involvement of two or more areas of the body. The tumors may occasionally be arranged in a linear fashion, but a pattern as seen in our patient suggests a naevoid condition and is extremely rare. The reason for this appearance is not clear. Perhaps the mutant gene involves the mesenchymal tissue in the lines of Blascho. Some authors have described extensive leiomyomas with a naevoid distribution as nevus leiomyomatosis systematicus.[3],[4] In our patient, the lesions were not systematized. Treatment of multiple leiomyomas is difficult.[5]

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