Rare case of asymptomatic cutaneous leiomyomatosis in 65-year-old patient

Introduction. Cutaneous leiomyomas are rare solitary or multiple benign intradermal neoplasms arising from smooth muscle cells in adolescence or early adulthood. Multiple leiomyomas appear as superficial firm papules or nodules that form clusters in linear or dermatomal distribution. Majority of leiomyomatosis patients have fumarate hydratase gene mutation associated with early-onset cutaneous and uterine lesions (Reed’s syndrome) and early-onset renal cell cancer.
Over time cutaneous leiomyomas may develop painful paroxysms that appear spontaneously or are induced by physical or emotional stimuli. Leiomyomatosis should be differentiated from a broad spectrum of benign and malignant lesions such as leiomyosarcoma and cutaneous metastases.
Case description. A 65-year-old woman presented to the dermatologist’s office with a 10-year history of slowly growing, painless, firm lump on her left breast. Patient’s medical history was not significant except breast augmentation surgery 30 years ago. On examination solid, nodular, well-demarcated, painless tissue mass, approximately 1.5 cm in diameter was seen on the left breast and multiple small nodules of similar structure arranged in zosteriform distribution were seen on patients left trunk and back. An excisional biopsy was performed with histopathological findings consistent with the suspected clinical diagnosis of leiomyomatosis.
Conclusions. Excisional biopsy is relatively safe treatment method for solitary lesions, however gradual increase in tumor size and quantity can lead to disfiguring appearance of the skin and declining surgical treatment efficacy.
Summary. This report presents a rare case of an asymptomatic patient with multiple cutaneous leiomyomas. Thorough evaluation (genetic testing, gynaecological examination and renal imaging) needs to be performed in order to exclude Reed’s syndrome and hereditary leiomyomatosis and renal cell cancer.