Popov Hristo, Petkova Lilyana, Stoyanov George S
General and Clinical Pathology/Forensic Medicine and Deontology, Medical University of Varna, Varna, BGR.
General and Clinical Pathology, St. Marina University Hospital, Varna, BGR.
Cureus. 2022 Dec 20;14(12):e32717. doi: 10.7759/cureus.32717. eCollection 2022 Dec.
Leiomyosarcomas are rare malignant mesenchymal neoplasms originating from smooth muscle cells. Although leiomyosarcoma is commonly located in the female reproductive system, gastrointestinal tract, and subcutaneous tissues, it is a rare entry in the head and neck area, probably due to the scarcity of smooth muscle tissue in this topographical region. Herein we present a histopathological case report of a 60-year-old male with a slow-growing painless mass on the middle third of the right lateral lingual margin, with focal ulceration measuring 1x1.5cm. After gross excision, histopathology revealed pleomorphic spindle cells, some with bizarre nuclei and abundant pathological mitotic activity with a tendency to grow in a fascicular pattern. As the patient had the demographic characteristic and risk factors for oral cavity squamous cell carcinoma, a spindle-shaped variety (sarcomatoid) variety was suspected, and immunohistochemistry with a broad set of antibodies was used to prove the histogenetic group of the tumor. As the tumor was pan-cytokeratin and desmin negative, focally positive for caldesmon, and positive for smooth muscle actin, the diagnosis of pleomorphic leiomyosarcoma of the tongue was established.
平滑肌肉瘤是一种罕见的起源于平滑肌细胞的恶性间叶性肿瘤。虽然平滑肌肉瘤常见于女性生殖系统、胃肠道和皮下组织，但在头颈部区域却较为罕见，这可能是由于该解剖区域平滑肌组织较少。在此，我们报告一例组织病理学病例，患者为60岁男性，右侧舌缘中1/3处有一生长缓慢的无痛性肿块，伴有一处1×1.5厘米的局灶性溃疡。大体切除后，组织病理学显示为多形性梭形细胞，部分细胞具有奇异核，有丰富的病理性核分裂象，呈束状生长趋势。由于该患者具有口腔鳞状细胞癌的人口统计学特征和危险因素，怀疑为梭形（肉瘤样）变种，遂使用一系列广泛的抗体进行免疫组化以证实肿瘤的组织发生类型。由于肿瘤全细胞角蛋白和结蛋白阴性，钙调蛋白局灶性阳性，平滑肌肌动蛋白阳性，故确诊为舌部多形性平滑肌肉瘤。
