Yonago Acta medica 2002;45:113–116

Vascular Leiomyoma of the Nasal Cavity: Case Report and Review ofthe Literature
Mari Osaki, Mitsuhiko Osaki, Isamu Kodani, Hironobu Adachi, Itoji Shibata*and Hisao Ito
Division of Organ Pathology, Department of Microbiology and Pathology, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503 and *Shibata Otorhinolaryngoly Clinic, Tottori 680-0862 Japan
We reported a rare case of nasal vascular leiomyoma that developed in a 67-year-oldman. The tumor showed characteristic histological findings with proliferation of smoothmuscle cells intermingled with dilated venous vessels. Review of the literature indicatedthat nasal vascular leiomyoma is characterized by female predominance, occurrence inaged patients and nasal obstruction or pain as the primary symptom.
Key words: immunohistochemistry; nasal cavity; vascular leiomyoma

Leiomyomas are benign myogenic neoplasmsthat may occur wherever smooth muscle ispresent. According to Enzinger and Weiss(1995), who analyzed a total of 7,748 leiomyomas, 95% of the tumors occurred in the female
genitalia (uterus), 3% in the skin, 0.9% in thegastrointestinal tract and the remainder in various sites. Leiomyomas are classified into 3 histological subtypes: vascular, nonvascular andepithelioid or leiomyoblastoma (Batsakis,1979). Vascular leiomyoma is a relatively uncommon smooth muscle tumor rarely found in
the neck and head area. Herein, we present arare case of vascular leiomyoma developed in
the nasal septum.

Patient Report
A 67-year-old man visited an otorhinolaryngoly
clinic in June 1999, with a 2-week history ofleft-sided nasal obstruction and intermittent
bloody discharge. He had no other symptoms
such as headache, pain or epistaxis. Physicalexamination revealed a round wide-based massmeasuring 8 mm in diameter on the left nasal septum, covered with a dark reddish nasal mucous
membrane. No teleangiectasis or bleeding wasnoted. He was followed up for about 6 months.

Thereafter, the tumor was completely excisedwith marginal normal nasal mucosa. Postoperative recovery was uneventful. The patient
has shown no recurrence of the tumor and waswell 15 months postoperatively.

Pathological findings
The resected specimen measured about 10 mmin diameter, including peripheral normal mucosa. The cut surface showed a homogeneous,pale tan tissue without obvious hemorrhage ornecrosis.
Histologically, the squamous epithelia
covering the tumor showed slight hyperkeratosis, but not cellular atypia (Fig. 1). The tumor
was composed of elongated blunt-shaped spindle cells intermingled with numerous irregularly dilated blood vessels, which had a thin single
layer of endothelial cells (Fig. 2). Mitoses were
not noted. The margin of the tumor was circumscribed, despite the absence of a fibrouscapsule.
Formalin-fixed, paraffin-embedded sections
were immunohistologically stained with theavidin-biotin peroxidase complex method, using
commercially available antibodies for desmin,
factor VIII, CD-34, α-smooth muscle actin,
muscle-specific actin-HHF-35 and myoglobin.

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Fig. 1. Solid-type tumor showing compacted vascular vessels and muscles measuring
about 8 mm in diameter. This tumor is thickly encapsulated by squamous cells withslight hyperkeratosis (hematoxylin and eosin stain; original magnification × 50).

Fig. 2. Thick muscular walled-vessels and intervascular smooth muscle bundles(hematoxylin and eosin stain; original magnification × 50).

The tumor cells as well as the walls of the bloodvessels showed marked immunoreactivity fordesmin, α-smooth muscle actin (Fig. 3) andmuscle-specific actin-HHF-35, but not for
myoglobin. The lining endothelial cells of thedilated vessels showed positive immunostaining for factor VIII and CD-34.

Discussion
Leiomyomas developing in the nasal cavity andparanasal sinuses are extremely rare. Maesaka
et al. (1966) initially reported an intranasal leiomyoma in 1966. To the best of our knowledge,
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Vascular leiomyoma of nasal cavity

35 nasal leiomyomas have been subsequently
reported until now. Of these, only 5 tumors
developed in the nasal septum (Timiryaleev,1973; Barr et al., 1990; Trott et al., 1994;
Llorente et al., 1996), and 16 cases including
the present tumor were histologically classified
as vascular type (Table 1), which involved 11
females (mean age: 54.4 years, ranging from 25to 76) and 5 males (mean age: 55.0 years, ranging from 33 to 77). Prominent clinical symptoms are nasal obstruction and pain, and nasal
bleeding is rather less frequent. The tumor developed most frequently in the lower extremities, followed by the upper extremities and lessfrequently in the nasal septum (Hachisuga et al.,1984). Thus, nasal vascular leiomyoma might
be characterized by female predominance, occurrence in aged patients, and nasal obstruction or
pain as the primary symptom.
According to the report written by Morimoto(1973), vascular leiomyomas were classified
into 3 histological subtypes: solid or capillary,cavernous and venous. The venous type developed most frequently in the head and neck. Histologically, the venous type has vascular channels with thick muscular walls that are easily
discernible from smooth muscle bundles, as observed in the present case. Although we conducted immunohistochemical analysis forFig. 3. Most of the spindle cells showing strong
positive cytoplasmic reactivity for α-smooth muscle
actin on the left side of the lesion (peroxidase antiperoxidase method for α-smooth muscle actin
antigen; original magnification × 50).

Table 1. Reported cases of vascular leiomyoma of the nasal cavity
AuthorsSex/age (year)

Location

Maesaka et al.
(1966)
Schwartzman et al. (1973)

F /49
M /57

Wolfwitz et al.
Kambayashi
McCaffrey et al.
Hanna et al.
Zijlker et al.

(1973)(1978)(1978)(1988)(1989)

F /42
F /55
F /76
F /64
M /33

Vestibule
Maxillary, ethmoid, sphenoid,
posterior nasal fossa
Inferior turbinate
Vestibule
Inferior turbinate
Inferior turbinate
Ethmoid

Ragbeer et al.
Sawada et al.
Harrison et al.
Khan et al.
Trott et al.
Nall et al.
Murono et al.
Present case(1990)(1990)(1993)(1994)(1966)(1996)(1998)F /49
M /41
F /55
F /71
M /77
F /43
F /69
M /67

Anterior nasal floor
Vestibule
Ethmoid
Inferior turbinate
Inferior turbinate
Superior turbinate
Inferior turbinate
SeptumF, female; M, male.

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Symptom
Pain
Nasal obstruction, headache
Nasal obstruction—Epistaxis
Nasal obstruction, epistaxis, pain
Periorbital swelling, nasal discharge, nasal obstruction
Pain, nasal discharge
Tumor in nostril
Epiphora, swelling
Nasal obstruction
Epistaxis
Nasal obstruction, epistaxis, pain
Epistaxis
Nasal obstruction

M. Osaki et al.

academic interest, histopathological diagnosis
is easily done with routinely stained hematoxylin and eosin sections. Malignant transformation of vascular leiomyoma has not been reported, in spite of local recurrence in a few
cases (2 of 562 cases) (Hachisuga, 1984). It
should be stressed that otorhinolaryngologists
should have an awareness of the possible existence of vascular leiomyoma in the nasal cavity.

References
1 Barr GD, More IAR, McCallum HM. Leiomyoma of the nasal septum. J Laryngol Otol 1990;
104:891–893.
2 Batsakis JG (ed). Tumors of the head and neck:clinical and pathological considerations. 2nd ed.
Baltimore, MD: Williams & Wilkins; 1979. p.
354–356.
3 Enzinger FM, Weiss SW. Soft tissue tumors. 3rded. St Louis: Mosby; 1995. p. 467–489.
4 Hachisuga T, Hashimoto H, Enjoji M. Angioleiomyoma: a clinicopathologic reappraisal of562 cases. Cancer 1984;54:126–130.
5 Hanna GS, Akosa AB, Ali MH. Vascular leiomyoma of the inferior turbinate: report of a caseand review of the literature. J Laryngol Otol
1988;102:1159–1160.
6 Harrison D, Lund VJ. Tumors of muscle origin.
In: Harrison D, Lund VJ, eds. Tumours of the upper jaw. Edinburgh, United Kingdom: Churchill
Livingstone; 1993. p.187–197.
7 Kambayashi J. Vascular leiomyoma of the nasalvestibule. J Jpn Otolaryngol (Tokyo) 1976;50:313–316.
8 Khan MHZ, Jones AS, Haqqani MT. Angioleiomyoma of the nasal cavity: report of a case andreview of the literature. J Laryngol Otol 1994;
108:244–246.
9 Llorente JL, Suarez C, Seco M, Garcia A. Leio-myoma of the nasal septum: report of a case andreview of the literature. J Laryngol Otol 1996;
110:65–68.
10 Maesaka A, Keyaki Y, Nakanishi T. Nasal angioleiomyoma and leiomyosarcoma: report of 2cases. Otologia (Fukuoka) 1966;12:42.
11 McCaffrey TV, McDonald TJ, Unni KK. Leiomyoma of the nasal cavity: report of a case. JLaryngol Otol 1978;92:817–819.
12 Morimoto N. Angiomyoma (vascular leiomyoma):a clinicopathologic study. Med J Kagoshima Univ
1973;24:663–683.
13 Murono S, Ohmura T, Sugamori S, Furukawa M.
Vascular leiomyoma with abundant adipose cellsof the nasal cavity. Am J Otolaryngol 1998;19:50–53.
14 Nall AV, Stringer SP, Baughman RA. Vascularleiomyoma of the superior turbinate: first reportcase. Head Neck 1996;19:63–67.
15 Ragbeer MS, Stone J. Vascular leiomyoma of thenasal cavity: report of a case and review of literature. J Oral Maxillofac Surg 1990;48:1113–1117.
16 Sawada Y. Angioleiomyoma of the nasal cavity.
J Oral Maxillofac Surg 1990;48:1100–1101.
17 Schwartzman J, Schwartzman J. Leiomyoangioma of paranasal sinuses: case report. Laryngoscope 1973;83:1856–1858.
18 Timiryaleev, MKH. Angioleiomyoma of thenasal septum. Vestn Otolaryngol 1973;35:106.
19 Trott MS, Gewirtz A, Lavertu P, Wood BG,Sebek BA. Sinonasal leiomyomas. Otolaryngol
Head Neck Surg 1994;111:660–664.
20 Wolfwitz BL, Schmaman A. Smooth muscle tumours of the upper respiratory tract. S Afr Med J
1973;47:1189–1191.
21 Zijlker TD, Visser R. A vascular leiomyoma ofthe ethmoid. Report of case. Rhinology 1989;
27:129–135.
Received September 25, 2002; accepted October 7, 2002

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Corresponding author: Mitsuhiko Osaki