Cellular leiomyoma of the nasal cavity

Fig. 3. The tumor cells were composed of spindle cells. Hematoxylin-eosin, original magnification × 200

Fig. 4. The tumor cells were diffusely positive for alpha smooth muscle actin. Immunostaining for alphasmooth muscle actin (original magnification × 200).

et al., 1989; Barr et al., 1990; Ragbeer and Stone,
1990; Sawada, 1990; Van Ingen et al., 1991; Khanet al., 1994; Ardekian et al., 1996; Llorente et al.,1996). Therefore, the present case is very rare.

The rarity of smooth muscle tumors in the nasalcavity and paranasal sinuses is probably due tothe paucity of smooth muscle fibers in this location.
87

S. Horie et al.

Table 1. Previous cases of leiomyoma of the nasal cabity and paranasal sinuses
Author(s)
123
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

Reference number

Maesaka et al.
Ram
Schwartzman and Schwartzman
Wolfwitz and Schmaman
Kotaka and Furuya
Timirgaleev
Fu and Perzin
McCaffrey et al.
Papavasiliou and Michaels
Lijovetzky et al.
Daisley
Tang and Tse
Hanna et al.
Nam et al.
Ragbeer and StoneSawada
Barr et al.
Van Ingen et al.
Harcourt and Gallimore
Khan et al.
Llorente et al.
Ardekian et al.
Nall et al.
Horie et al.

16
21
23
27
1125
61419
12424
818
20
22
226
91013
1
17
Present case

Year
1966
1971
1973
1973
1973
1973
1975
1978
1981
1985
1987
1988
1988
1988
1990
1990
1990
1991
1993
1994
1996
1996
1997
2001

Location
Vestibule
Inferior turbinate
Sinuses and nasal fossa
Inferior turbinate
Nasal cavity
Nasal septum
Nasal cavity
Inferior turbinate
Middle turbinate
Vestibule
Middle turbinate
Inferior turbinate
Inferior turbinate
Vestibule
Nasal floorVestibule
Nasal septum
ChoanaEthnocide sinus
Inferior turbinate
Nasal septum
Nasal septum
Superior turbinate
Nasal septum1989). In our case, the tumor was strongly
positive for alpha smooth muscle actin, supporting the diagnosis of leiomyoma.
The current treatment is surgical resection
and there are only a few reports of recurrence inthe literature (Hanna et al., 1988; Khan et al.,1994). Because of the vascularity of the lesionin this case, we elected to embolize the feeding
vessels prior to surgical resection.
In summary, leiomyomas of the nasal cavity
are extremely rare. This case is the 24th reported case in the literature. The exact origin of
these tumors is not known, but most agree thatthe etiology is probably from smooth muscle
cells in the walls of blood vessels. Surgical excision of these benign tumors yields high curerates.

Leiomyomas of the skin and subcutis areusually divided into vascular and nonvascular
types. In the nasal cavity, three hypotheses
have been given for the origin of smooth muscle
tumors: from aberrant undifferentiated mesenchyme; from smooth muscle elements in thewall of blood vessels; or from both sources(Batsakis, 1979). Most of the authors support
the idea that the vascular smooth muscle is theorigin of the tumor.
In agreement with Barr et al. (1990) andLlorente et al. (1996), we think that the origin of
this type of nasal septal leiomyoma is from thesmooth muscle component of a blood vessel,because of the absense of the other types ofmuscle in the septum.
In the present case, the cellularity of thetumor was higher than the usual leiomyoma inother sites. We diagnosed this case as cellularleiomyoma. There have not been any reported
cases of cellular leiomyoma of the nasal cavity.
Several stains have been used to identify leiomyoma including desmin, vimentin, Masson’s
trichrome, actin and myosin (Maeda and Osaki,References
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88

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Received December 11, 2000; accepted January 5, 2001
Corresponding author: Prof. Tadashi Terada89