Yonago Acta medica 2001;44:85–89

Cellular Leiomyoma of the Nasal Cavity: Report of a Case and Reviewof Literature
Satoshi Horie, Kensaku Hasegawa* and Tadashi Terada
Second Department of Pathology, Tottori University Faculty of Medicine, Yonago 683-0826
Japan and *Clinic of Otolaryngology, Public Yoka Hospital, Yoka 667-8555 Japan
We report a rare case of cellular leiomyoma in the nasal cavity. A 72-year-old Japanese
woman was admitted to a hospital. A tumoral lesion was revealed in the left nasalcavity. Angiography showed tumor staining, and the tumor was endoscopically resected
after the embolizaion of the feeding artery. At gross inspection, the tumor measured
1.0 × 1.5 × 2.0 cm. Microscopically, the tumor consisted of many spindled cells withblunt ended nuclei. Immunohistochemical examination revealed that the tumor cells
were positive for vimentin, alpha smooth muscle actin. We diagnosed this case as cellularleiomyoma. To the best of our knowledge, there have been only 23 reported cases ofnasal leiomyoma in English medical literature. We made a brief literature review ofthe occurrence of this tumor in the nasal cavity.
Key words: cellular leiomyoma; nasal cavity

Leiomyoma is a benign smooth muscle tumor
found mainly in the uterus, skin, gastrointestinal tract, deep soft tissues, peritoneum andother sites. Enzinger and Weiss (1995) reported
that 95% of leiomyoma (7,748 cases) were located in the female genitalia, 3% in the skin andthe remainder in other sites. They are quite unusual in the nasal cavity and paranasal sinuses,
and a search of the literature revealed only 23
reports (Maesaka et al., 1966; Ram, 1971; Kotakaand Furuya, 1973; Schwartzman and Schwartzman,1973; Timirgaleev, 1973; Wholfowitz andSchmaman, 1973; Fu and Perzin, 1975; Nall et al.,
1997; MaCaflley et al., 1978; Papavasiliou andMicheaels, 1981; Lijovetzky et al., 1985; Daisley,1987; Hanna et al., 1988; Harcourt and Gallimore,1988; Tang and Tse, 1988; Nam et al., 1989; Barret al., 1990; Ragbeer and Stone, 1990; Sawada,1990; Van Ingen et al., 1991; Khan et al., 1994;
Ardekian et al., 1996; Llorente et al., 1996).
We report the clinical and histological features of a rare case of the intranasal leiomyoma
including its immunohistochemistry.

Patient report

Clinical Summary
A 72-year-old Japanese woman was admitted toa hospital with a history of temporal epistaxis.
She had no other symptoms such as headache,pain, nasal discharge or anosmia. Her past
medical history showed only bronchial asthma.
On initial physical examination, a mass measuring 1.0 × 2.0 cm was located on the nasal
septum of the left nasal cavity. A computed tomography scan of the head showed a solid massmeasuring 0.8 × 1.0 × 2.0 cm in the left nasal
cavity (Fig. 1). Angiography revealed tumor
stainings (Fig. 2). Selective embolization of
the feeding artery was performed. Resection of
the tumor by endoscopic nasal surgery was performed. Postoperative recovery was uneventful
with the exception of slight bleeding. She wasdischarged from the hospital, and there has been
no recurrence since.

85

S. Horie et al.

Pathologic Findings
On gross examination, the resected specimen consisted of a grayish-pink tissue
measuring 1.0 × 1.5 × 2.0 cm. Microscopically, the mass consisted of spindle cells
which lay in the submucosa and was partially covered by non-keratinizing stratified squamous epithelium. The cellularityof the tumor was high. The cells had bluntended oval nuclei and minimal nuclear
pleomorphism (Fig. 3). No mitotic figures
were observed.
For confirmation, an immunohistochemical study was performed. The tumor
cells were negative for epithelial membrane antigen, cytokeratin, and S-100, but
positive for vimentin and alpha smoothmuscle actin (Fig. 4).

ADiscussion

BFig. 1. Computerized tomography sections of axial (A)and coronal (B) views of the tumor (arrows) seen in theleft nasal cavity.

Fig. 2. Preoperative angiography showing tumor
stainings (arrow) from a left internal maxillary artery.

86

We diagnosed this case as cellular leiomyoma because of its histology and thestrongly positive myogenic marker (alphasmooth muscle actin). Differential diagnosis included angiofibroma, epithelioid leiomyoma, hemangiopericyioma and schwannoma. Immunohistochemically, angiofibroma and schwannoma were not probable. Because most of the tumor cells had aspindle shape, showing a fascicular pattern, leiomyoma was probable rather thanepithelioid leiomyoma or hemangiopericytoma.
To the best our knowledge, there havebeen previously only 23 reported cases ofleiomyoma involving the nasal cavity andparanasal sinuses (Table 1) (Maesaka et al.,
1966; Ram, 1971; Kotaka and Furuya, 1973;
Schwartzman and Schwartzman, 1973;
Timirgaleev, 1973; Wholfowitz andSchmaman, 1973; Fu and Perzin, 1975; Nallet al., 1997; MaCaflley et al., 1978; Papavasiliouand Micheaels, 1981; Lijovetzky et al., 1985;
Daisley, 1987; Hanna et al., 1988; Harcourt andGallimore, 1988; Tang and Tse, 1988; Nam