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A Journal on Dermatology

Journal of Istituto Dermatologico San Gallicano
Official Journal of the Associazione Dermatologi Ospedalieri Italiani - A.D.O.I.
Indexed/Abstracted in: EMBASE, Scopus



Esperienze Dermatologiche 2009 September;11(3):123-6


language: English, Italian

Primary cutaneous leiomyosarcoma

Calista D. 1, Nuzzo F. 2, Arcangeli F. 1

1 Dipartimento di Dermatologia, Ospedale M. Bufalini, Cesena, Forlì-Cesena 2 Dipartimento di Anatomia Patologica, Ospedale M. Bufalini, Cesena, Forlì-Cesena


Leiomyosarcomas are rare soft-tissue neoplasms characterised by a high infiltrative tendency and a high risk of relapse. Two-thirds of leiomyosarcomas are localised in the retroperitoneal space and the remaining third arise between the dermis and the hypodermis, respectively from arrector pili muscles and vascular smooth muscle. Primary cutaneous leiomyosarcomas mainly affect males between the fifth and seventh decades of life and present a completely aspecific clinical appearance, characterised by a papula, a plaque or a solitary, indolent, firm nodule. Given the difficulty of clinical diagnosis only a histological examination allows the formulation of a correct nosological classification. Under the microscope, beneath a grenz zone overlain by an integral epithelium, leiomyosarcoma appears as an undefined mass, composed of spindle cells organised into orthogonal bundles, occupying the dermis and the hypodermis. The cells have elongated “cigar-shaped” nuclei and eosinophilic cytoplasm. Sometimes a cytoplasmic perinuclear halo is perceptible. Mitotic figures are frequent. The immunohistochemical profile shows positivity for anti-smooth muscle antibodies, while anti-desmin and vimentin antibodies lead to aspecific reactions. The differential diagnosis must take into account dermatofibrosarcoma protuberans, malignant fibrous histiocytoma, leiomyoma and fibrosarcoma. The tendency to metastasise is directly proportional to the volume of the neoplasm. This article presents the case of a 77-year-old male patient suffering from primary cutaneous leiomyosarcoma of the left thigh.

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