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Leiomyoma of Skull base
Leiomyoma of Skull base
Leiomyoma of Skull base
Leiomyoma of Skull base
Leiomyoma of Skull base
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Leiomyoma of Skull base

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Leiomyoma is a benign tumor that originates from smooth …

Leiomyoma is a benign tumor that originates from smooth
muscle cell. The most common sites are the uterus, gastrointestinal tract & skin. Leiomyoma is a relatively uncommon smooth muscle tumor rarely found in the head and neck. Enzinger and Weiss (1995), analyzed a total of 7748 leiomyomas, 95% of the tumors occurred in the female genitalia (uterus), 3% in the skin, 0.9% in the gastrointestinal tract and the remainder at various sites including skull base.

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  • 1. Leiomyoma of Skull base
  • 2. a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 2 4 0 e2 4 2 Available online at www.sciencedirect.com journal homepage: www.elsevier.com/locate/apme Case Report Leiomyoma of skull base Rajendra Prasad a,*, Amit Kapoor a, Shyam Sunder b a b Department of Neurosurgery, Apollo Hospital, New Delhi, India Department of Neurosurgery, Udayan Hospital, Patna (Previously at Apollo Hospital, New Delhi), India article info abstract Article history: Leiomyoma of the skull base is an extremely rare tumor and is not well documented. In Received 31 July 2013 this article, we report a case of a leiomyoma of the skull base in a 17 years old African male Accepted 7 August 2013 whose initial diagnosis was a sphenoidal wing meningioma. Available online 6 September 2013 Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved. Keywords: Benign mesenchymal tumor of skull base Leiomyoma of skull base Rare intracranial tumors 1. Introduction Leiomyoma is a benign tumor that originates from smooth muscle cell. The most common sites are the uterus, gastrointestinal tract & skin. Leiomyoma is a relatively uncommon smooth muscle tumor rarely found in the head and neck.3 Enzinger and Weiss (1995), analyzed a total of 7748 leiomyomas, 95% of the tumors occurred in the female genitalia (uterus), 3% in the skin, 0.9% in the gastrointestinal tract and the remainder at various sites including skull base. We review the literature of mesenchymal tumors of the skull base. We report an extremely rare case of a leiomyoma of the skull base. 2. Case report A 17-year-old African male presented to us with a history of protrusion of the left eye ball of one year duration, along with progressive loss of vision in the left eye of three months duration. On examination he had axial proptosis of the left eye. There was no perception of light in the left eye. There was no motor or sensory deficit in the limbs. He was referred for surgery with a diagnosis of sphenoidal wing meningioma. He underwent staged excision of the lesion. Since the lesion appeared vascular on MRI he underwent tumor embolization of the feeders from both the internal carotid artery (ICA) and external carotid artery (ECA). Fortyeight hours later he underwent left frontotemporal craniotomy and microscopic decompression of the tumor. As the medial portion of tumor was attached to the cavernous sinus and was very vascular it was decided to stage the tumor resection. One week after the first surgery there was no improvement in vision in the left eye and visual evoked potential did not elicit any response. He then underwent left ophthalmic artery embolization followed by left lateral rhinotomy through a transfacial approach and decompression of the residual lesion. Since the tumor was benign in nature, * Corresponding author. Tel.: þ91 09810048369. E-mail address: neurosurgeryindia@gmail.com (R. Prasad). 0976-0016/$ e see front matter Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved. http://dx.doi.org/10.1016/j.apme.2013.08.008
  • 3. a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 2 4 0 e2 4 2 241 Fig. 1 e Pre operative MRI (T1 contrast). it was decided to follow-up the small residual portion of the tumor involving the cavernous sinus and not to give stereotactic radiation till there was evidence of tumor growth. Pre operative MRI (T1 contrast) Brain (Plain and Contrast) showed a well defined extra axial intensely enhancing mass lesion in left parasellar region extending into the left orbit, left infratemporal fossa, left ethmoid, sphenoid and maxillary sinuses with erosion of adjacent bones [Fig. 1]. Post operative MRI showed: Residual mass in left parasellar region with intraorbital extension through left optic nerve canal and displacing left optic nerve [Fig. 2]. Post-operative (T1 contrast) showing a very small residual tumor [Fig. 3]. Histopathology showed a cellular neoplastic lesion, composed of neoplastic cells arranged in the form of sheets, whorls and fascicles. The cells had indistinct cells borders with oval to spindle shaped nuclei. Foci of dystrophic calcification were seen. No mitotic activity was evident. It was reported to be a leiomyoma, a benign mesenchymal neoplasm [Fig. 4]. At 3 years follow-up the patient is neurologically preserved except for visual loss in the left eye and no proptosis. There has been no increase in the size of the residual lesion. Enzinger and Weiss (1995), analyzed a total of 7748 leiomyomas, 95% of the tumors occurred in the female genitalia (uterus), 3% in the skin, 0.9% in the gastrointestinal tract and the remainder in various sites including the skull base.1,2 Tumors of mesenchymal origin that affect the skull base are rare and in a series of 322 lateral skull base procedures, ten (0.3%) were performed for sarcomas, or their histologically benign equivalent.3 These tumors were chondrosarcoma, chondroid chordoma, leiomyosarcoma, synovial sarcoma, myxoma and fibrous dysplasia. In a case report of four cases of unusual dural and skull-based mesenchymal neoplasms, there was case of leiomyoma of the suprasellar region in a 57-year-old woman and a patient of EBV-associated leiomyosarcoma of the left dural transverse sinus.4 Leiomyomas of skull base are rare tumors. As these tumors can be vascular preoperative embolization is of immense help in surgical decompression of these lesions. Complete surgical Fig. 2 e MRI T1 Brain Contrast after 1st surgery. Fig. 3 e Post-operative MRI after 2nd surgery. 3. Discussion
  • 4. 242 a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 2 4 0 e2 4 2 Fig. 4 e Histopathology slides. excision should be the aim. We do not recommend radiation, as these are benign tumors. Conflicts of interest All authors have none to declare. Acknowledgment We acknowledge the help of our researcher Ms. Meenakshi Mohan who helped in the follow-up and compiling data of these patients. references 1. Osaki M, Osaki M, Kodani I. Vascular leiomyoma of the nasal cavity: case report and review of the literature. Yonago Acta Med. 2002;45:113e116. 2. Fisch U, Mattox D. Microsurgery of the Skull Base. New York: Thieme; 1988. 3. Shotton JC, Fisch U. Mesenchymal tumors of the skull base with particular reference to surgical management and outcome. Skull Base Surg. 1992;2(2):112e117. 4. Kleinschmidt-demasters BK, Mierau GW, Sze CI, et al. Unusual dural and skull-based mesenchymal neoplasms: a report of four cases. J Human Pathology. 1998;29(3): 240e245.
  • 5. A o oh s i l ht:w wa o o o p a . m/ p l o p a : t / w .p l h s i lc l ts p / l ts o T ie: t s / ie. m/o p a A o o wt rht :t t r o H s i l p l t p /w t c ts l Y uu e ht:w wy uu ec m/p l h s i ln i o tb : t / w . tb . a o o o p a i a p/ o o l ts d F c b o : t :w wfc b o . m/h A o o o p a a e o k ht / w . e o k o T e p l H s i l p/ a c l ts Si s ae ht:w wsd s aen t p l _ o p a l e h r: t / w .i h r.e/ o o H s i l d p/ le A l ts L k d : t :w wl k d . m/ mp n /p l -o p a i e i ht / w . e i c c a y o oh s i l n n p/ i n no o a l ts Bo : t :w wl s l e l . / l ht / w . t a h a hi g p/ e tk t n

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