Case Report
134
Leiomyoma of the Hand Mimicking a Pearl Ganglion
Wen-E Yang, MD; Swei Hsueh1, MD; Chih-Hua Chen, MD; Zhon-Liau Lee, MD;
Wen-Jer Chen, MD
Leiomyomas rarely occur in the hand. To our knowledge, there have been no reports of
a leiomyoma of the hand mimicking a pearl ganglion in the English literature. We report
such a case with a leiomyoma of the right third finger in a 59-year-old woman. The tumor
was excised together with the underlying sheet of tissue. The pathology revealed that the
tumor was linked to the underlying structure of a vascular wall by a stalk of tumor tissue.
This report serves to remind clinicians to include leiomyoma in the differential diagnosis
when encountering a 'ganglion-like lesion'. Also, this report demonstrates the link between a
leiomyoma and its underlying origin. (Chang Gung Med J 2004;27:134-7)
Key words: leiomyoma, pearl ganglion.
L
eiomyomas, which are benign tumors of smoothmuscle origin, rarely occur in the hand.(1,2) To
our knowledge, there have been no reports of a
leiomyoma of the hand mimicking a pearl ganglion
in the English literature.(3) We describe such a case
of a painful leiomyoma of the hand.
bluish nodule with a firm, rubbery consistency arising from a vessel wall with a stalk connecting the
nodule to the vessel wall structure. The nodule was
4 mm in diameter. Histological examination demonstrated a typical microscopic appearance of a leiomyoma with intertwining bundles of smooth-muscle
cells, and no mitotic figure was seen (Fig. 1).
CASE REPORT
A 59-year-old woman presented with a painful
nodule on her right long finger. Physical examination revealed a deeply seated nodular lesion about 5
mm in diameter, at the distal palmar crease of the
right palm. The lesion was tender to palpation, and
she had had pain on gripping for the previous 3
months. No other masses were detected in the hand
or the upper extremity. With use of local anesthesia
without a tourniquet, en bloc excision of the nodule
was performed. A transverse incision was made in
line with the distal palmar crease. The nodule
together with the underlying sheet of tissue was
excised. The wound was primarily closed using nonabsorbable monofilament sutures. Pathological
analysis of the specimen revealed a smooth, discrete,
Fig. 1 Photomicrograph showing the storiform architecture
of spindle cells (H&E stain, Ű150).
From the Department of Orthopedic Surgery, 1Department of Pathology, Chang Gung Memorial Hospital, Taipei.
Received: Mar. 7, 2003; Accepted: Jun. 2, 2003
Address for reprints: Dr. Wen-E Yang, Department of Orthopedic Surgery, Chang Gung Memorial Hospital. 5, Fushing Street,
Gueishan Shiang, Taoyuan, Taiwan 333, R.O.C. Tel.: 886-3-3281200 ext. 2163; Fax: 886-3-3278113; E-mail:
yangwene@cgmh.org.tw
135
Wen-E Yang, et al
Leiomyoma of the hand mimicking a ganglion
Immunohistochemical staining for muscle-specific
actin with the HHF 35 antibody revealed that the
tumor was of a muscular origin (Fig. 2). At the 1year follow-up examination, there was neither evidence of local recurrence nor pain at the site of the
excision. The patient had full range of motion of the
wrist and fingers. There was no evidence of other
masses elsewhere in the body.
Fig. 2 Photomicrograph showing the brown-colored storiform architecture of spindle cells which reveals that the
leiomyoma is of muscular origin. (immunohistochemical
staining for muscle-specific actin, HHF35, Ű150).
DISCUSSION
Leiomyomas are benign tumors of smooth-muscle origin. Uterine leiomyomas are the most common
tumors in women.(4) Leiomyomas of the hand are
extremely rare and arise from non-striated muscles in
the upper extremity, such as erector pilli, sweat
glands, and vascular walls.(5) Most reports of leiomyomas of the hand have included only 1 or 2 patients
each.(1,2,6-11) Uchida et al.(12) reported on 11 patients
with a leiomyoma in the upper extremity. Neviaser
and Newman reported 24 leiomyomas of the hand
and forearm in their review of 85 vascular leiomyomas,(13) which we believe to be the largest series to
date. However, none of these reports had any similarity to our case. The only report of a leiomyoma
mimicking a pearl ganglion was in Polish.(3)
In general, leiomyomas occur in the third and
fourth decades of life.(4) The average age of patients
with a leiomyoma in the hand was reported to be
Chang Gung Med J Vol. 27 No. 2
February 2004
from 39 to 46 years.(12,13) These lesions are twice as
common in women and girls as in men and boys;
when they occur in the extremities, they are more
common in the leg, ankle, and foot than in the upper
extremity. (2) The most characteristic subjective
symptom of a leiomyoma is tenderness that evolves
into pain, which is often paroxysmal.(1) However,
Uchida et al. reported that leiomyomas in the hand
are usually not painful, but that lesions in the arm
and the forearm commonly are. There is difficulty in
differentiating a lesion like this case from a true pearl
ganglion as both present as a tiny painful nodule. A
possible preoperative diagnosis may require an
expensive imaging study such as magnetic resonance
imaging to differentiate the many possible other
tumors of the hand. Operative excision is the treatment of choice in these cases for both pathologic
diagnosis and for definite treatment. If an adequate
margin is obtained, recurrence of a leiomyoma is
rare.(1) There was no recurrence in this patient 2
years after the operation.
Our findings are exceedingly unusual, not only
because the leiomyoma developed in the hand, but
also because of its similarity to a ganglion. To our
knowledge, there has been no previous report of the
occurrence of a leiomyoma mimicking a ganglion in
the English literature. This report can serve to
remind clinicians to include leiomyoma in the differential diagnoses when encountering a 'ganglion-like
lesion'. This report also demonstrates the link
between a leiomyoma and its underlying origin.
REFERENCES
1. Duinslaeger L, Vierendeels T, Wylock P. Vascular leiomyoma in the hand. J Hand Surg[Am] 1987;12:624-7.
2. Robinson SC, Kalish RJ. Leiomyoma in the hand. A case
report. Clin Orthop 1990;255:121-3.
3. Tyszka JJ, Stypulkowski TA, Bieniawska M. Leiomyoma
diagnosed and treated as a ganglion. [in Polish] Chirurgia
Narzadow Ruchu i Ortopedia Polska. 1987;52:402-4.
4. Robbins SL, Cotran RS, Kumar V. Pathologic Basis of
Disease. Ed. 3, Philadelphia: W. B. Saunders Co., 1984:
1136-7.
5. Neviaser RJ, Adams JP. Vascular lesions in the hand.
Current management. Clin Orthop 1974;100:111-9.
6. Bogumill GP, Sullivan DJ, Baker GI. Tumors of the hand.
Clin Orthop 1975;108:214-22.
7. Duhig J T, Ayer JP. Vascular leiomyoma. A study of sixtyone cases. Arch Pathol 1959;68:424-30.
8. Firpo CA, Rimoldi MA, Bertole A. Leiomyomas of the
Wen-E Yang, et al
Leiomyoma of the hand mimicking a ganglion
hand. Internat Surg 1976;61:45-6.
9. Hauswald KR, Kasdan ML, Weiss DL. Vascular leiomyoma of the hand. Case report. Plast Reconstr Surg 1975;
55:89-91.
10. Oughterson AW, Tennant R. Angiomatous tumors of the
hands and feet. Surgery 1939;5:73-100.
11. Weisman PA. Blood vessel tumors of the hand. Plast
Reconstr Surg 1959;23:175-86.
12. Uchida M, Kojima T, Hirase Y, Iizuka T. Clinical characteristics of vascular leiomyoma of the upper extremity:
136
report of 11 cases. British J Plast Surg 1992;45:547-9.
13. Neviaser RJ, Newman W. Dermal angiomyoma of the
upper extremity. J Hand Surg 1977;2:271-4.
14. Boyd R, Bhatt B, Mandell G, Saxe A. Leiomyoma of the
hand: a case report and review of the literature. J Hand
Surg[Am] 1995;20:24-6.
15. Vaughn TR. Louton RB. Terranova WT. A large leiomyoma of the digit [letter]. Plast Reconstr Surg 1990;86:6056.
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