Multiple Cutaneous Leiomyoma Derived from the Mutation in Fumarate Hydratase Gene: A Case Report

푸마르산 수산화효소 유전자 결함에 따른 다발성 피부 평활근종의 치험례

  • Kim, Yoong Soo (Department of Plastic and Reconstructive Surgery, College of Medicine, Hallym University) ;
  • Tak, Kyoung Seok (Department of Plastic and Reconstructive Surgery, College of Medicine, Hallym University) ;
  • Cho, Chung Nam (Department of Plastic and Reconstructive Surgery, College of Medicine, Hallym University) ;
  • Chung, Chan Min (Department of Plastic and Reconstructive Surgery, College of Medicine, Hallym University) ;
  • Oh, Suk Joon (Department of Plastic and Reconstructive Surgery, College of Medicine, Hallym University) ;
  • Lee, Min Jin (Department of Pathology, College of Medicine, Hallym University)
  • 김융수 (한림대학교 의과대학 강남성심병원 성형외과학교실) ;
  • 탁경석 (한림대학교 의과대학 강남성심병원 성형외과학교실) ;
  • 조정남 (한림대학교 의과대학 강남성심병원 성형외과학교실) ;
  • 정찬민 (한림대학교 의과대학 강남성심병원 성형외과학교실) ;
  • 오석준 (한림대학교 의과대학 한강성심병원 성형외과학교실) ;
  • 이민진 (한림대학교 의과대학 해부병리학교실)
  • Received : 2007.05.30
  • Published : 2007.09.10

Abstract

Purpose: Multiple skin leiomyoma and uterine myoma bearing autosomal dominant traits are benign smooth muscle tumors which originate in skin or female uterus. Skin leiomyoma occurs after gene mutation originating from arrector pili muscle of hair follicle where its clinical manifestations vary significantly from person to person. Our department hereby reports the histological findings and genetic evaluations of this very rare disease. Methods: A 57-year-old woman presented in our institute with multiple tumors in the left and central parts of her back that started to appear since 19 years ago. The patient was diagnosed as having uterine myoma 15 years ago and underwent hysterectomy. Biopsy has been done on the specimen, and genomic DNA was separated from Fumarate hydratase gene for it to go through PCR amplification. The results of PCR amplification were aligned by sequencer. Results: According to the results of biopsy, tumor cells were spindle-shaped and were aligned in a bundle where there was no dysplasia or mitosis. Moreover, these cells had abundant eosinophilic cytoplasm with elongated nucleus, and benign leiomyoma that showed positive reactions to SMA stain were found. In genetic examination, mutations such as heterozygous single nucleotide substitutions were found in alignments of amplified DNA. Conclusion: Multiple skin leiomyoma and uterine myoma are relatively uncommon diseases that are transmitted through autosomally dominant traits from genetic mutations. When a patient's chief complaint lies upon skin-colored or brown masses that occur in multiples appearing in the trunk or extremities with characteristic clinical symptoms and histological findings, and when the patient's family history is acknowledged such as skin or uterine leiomyoma or renal tumor, necessary genetic examination on multiple skin leiomyoma and uterine myoma could be done, and thereby precise diagnosis could also be made.

Keywords

References

  1. Kiuru M, Launonen V, Hietala M, Aittomaki K, Vierimaa O, Salovaara R, Arola J, Pukkala E, Sistonen P, Herva R, Aaltonen LA: Familial cutaneous leiomyomatosis is a two-hit condition associated with renal cell cancer of characteristic histopathology. Am J Pathol 159: 825, 2001 https://doi.org/10.1016/S0002-9440(10)61757-9
  2. Toro JR, Nickerson ML, Wei MH, Warren MB, Glenn GM, Turner ML, Stewart L, Duray P, Tourre O, Sharma N, Choyke P, Stratton P, Merino M, Walther MM, Linehan WM, Schmidt LS, Zbar B: Mutations in the fumarate hydratase gene cause hereditary leiomyomatosis and renal cell cancer in families in north america. Am J Hum Genet 73: 95, 2003 https://doi.org/10.1086/376435
  3. Kim DH, Kang BS, Cho SH, Lee JD: A case of cutaneous leiomyoma presenting as a large nipple. Korean J Dermatol 44: 830, 2006
  4. Tomlinson IP, Alam NA, Rowan AJ, Barclay T, Jaeher EE, Kelsell D, Leigh I, Gorman P, Lamlum H, Rahman S, Roylance RR, Olpin S, Bevan S, Barker K, Hearle N, Houlston RS, Kiuru M, Lehtonen R, Karhu A, Vikki S, Laiho P, Eklund C, Vierimaa O, Aittomaki K, Hietala M, Sistonen P, Paetau A, Salovaara R, Herva R, Launonen V, Aaltonen LA: Germline mutations in FH predispose to dominantly inherited uterine fibroids, skin leiomyomas, and papillary renal cell cancer. Nat Genet 30: 406, 2002 https://doi.org/10.1038/ng849
  5. Alam NA, Barclay E, Rowan AJ, Tyrer JP, Calonje E, Manek S, Kelsell D, Leigh I, Olpin S, Tomlinson IP: Clinical features of multiple cutaneous and uterine leiomyomatosis: an underdiagnosed tumor syndrome. Arch Dermatol 141: 199, 2005 https://doi.org/10.1001/archderm.141.2.199
  6. Sahoo B, Radotra BD, Kaur I, Kumar B: Zosteriform pilar leiomyoma. J Dermatol 28: 759, 2001