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Leiomyoma

Leiomyoma — a benign tumor from smooth muscle cells.

Epidemiology

Myogenetic tumors make about 10% of all myagkotkanny new growths of skin. A ratio of smooth muscle tumors and new growths from striated muscles 100:1. Pilyarny leiomyomas make about 10% of all leiomyomas of skin. Multiple forms meet much more often than solitary. A ratio of women and men 2:1, at family cases — 8:1, at sporadic cases — 5:1.

Classification

• The leiomyoma developing from the muscle raising a hair (a pilyarny leiomyoma).
• The dartoid, or genital leiomyoma proceeding from the unstriated muscles of a cover of a scrotum, female external genitals or muscles squeezing a nipple of mammary glands.
• Angioleyomioma developing from muscular elements of small vessels of skin.
The modified classification of multiple leiomyomas of skin by E.I. Fadeyeva (2002):
• heredity: hereditary; sporadic (not hereditary);
• clinical option: multiple isolated, focal, mixed, special forms (as an illness to Darya, zosteriformny option, as a neurofibromatosis).

Etiology and pathogeny of a leiomyoma

At multiple leiomyomas with an autosomal and dominant mode of inheritance communication with some haplotypes of HLA-B8 is found.

Clinical signs and symptoms

The multiple leiomyoma arises at young age, is characterized by emergence of small small knots of color of normal skin, pink, red or other shades without subjective feelings. Small knots increase in the amount of and quantity. The first elements appear on extremities, is more rare — on a back, a breast, a face. Pain of various degree is available practically for all patients, usually pristupoobrazny character, lasting from several minutes to 1,5 — 2 h.

The solitary leiomyoma has the same appearance, but elements are much larger.

The diagnosis and the recommended clinical trials

The diagnosis is made on the basis of clinical signs and results of a biopsy.
The tumoral node of a pilyarny leiomyoma is accurately delimited from a surrounding derma and consists of the thick bunches of smooth muscle fibers intertwining among themselves between which there are narrow layers of connecting fabric. When coloring by Van-Gizona's method muscle bundles are painted in yellow color, and connecting fabric — in red. The tumor developing from diagonal muscles without clear boundary, has a similar structure, but bunches of muscle fibers are slightly thinner, lie more rykhlo. Between muscle bundles in scanty connecting fabric vessels of capillary type, sometimes with focal lympho-histiocytic infiltrates lie. Hypostasis and dystrophic changes can be observed. Existence of the expressed connective tissue stroma in painless tumors probably is one of the factors interfering an excessive prelum of nerve fibrils at reduction of unstriated muscles.
Angioleyomioma consists of a dense interlacing of bunches of the thin and short fibers which are located in places randomly, places in the form of concentric structures or turbulences. In fabric of a tumor there are a lot of cells with the extended kernels, intensively painted hematoxylin and eosine. Among these elements find many vessels with indistinctly expressed muscular coat which is directly passing into tumor fabric in this connection vessels have an appearance of the cracks which are located between bunches of muscle fibers. Depending on character of the prevailing vascular structures it is possible to allocate 4 main types of a structure of an angioleyomioma. Most often the angioleyomioma of arterial type, then venous and mixed, and also the low-differentiated angioleyomioma in which not numerous vessels, mainly decide on slit-like gleams meets. In some angioleyomioma it is possible to see lines of similarity to Barret's glomusangiomas — Masson. They are characterized by existence of the "epithelioid" cells making bulk of a tumor. In later terms in angio-leiomyomas it is possible to find various changes of secondary character in the form of sharp vasodilatation, the growths of connecting fabric leading to a sclerosis, hemorrhages with the subsequent formation of hemosiderin.

Differential diagnosis

Neurofibromatosis, Kaposha's sarcoma, leiomyosarcoma, neurinoma.

General principles of treatment of leiomyomas

Surgical excision, electroexcision of a solitary element are shown.
For stopping of pain are shown and - adrenoblockers in combination with blockers of calcium channels: Nifedipine about 10 mg 3 r / days are inside long
+
Prazozinum about 0,5 mg 3 r / days are inside long.

Forecast

At solitary tumors favorable, at multiple — rather favorable.
 
"Skin horn   Lymphangioma"