Published in:
01-06-2016 | The Last Image
Circumferential anorectal leiomyomatosis
Published in: Techniques in Coloproctology | Issue 6/2016
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A 57-year-old woman, who had oesophageal leiomyomatosis diagnosed 2 years ago, was referred for the management of a perianal lesion thought to be full-thickness rectal prolapse. The skin overlying the surface of this lesion led us to consider a circumferential plexus of external haemorrhoids as a differential diagnosis (Fig. 1). However, partial excision of the lesion revealed no haemorrhoidal tissue and demonstrated a rubbery and encapsulated lesion (Figs. 2, 3, 4, 5). Histological examination of the excised specimen established the unusual diagnosis of anorectal leiomyomatosis (Figs. 6, 7).
Fig. 1
Note the skin overlying the surface of this circumferential perianal lesion, as well as ulceration from pressure, resulting in bleeding and pain. This patient was previously thought to have full-thickness rectal prolapse
Fig. 2
Partial excision of the lesion demonstrating no haemorrhoidal tissue
Fig. 3
Image of the excision bed demonstrating a circumferential submucosal lesion
Fig. 4
An excisional biopsy of the encapsulated and submucosal lesion
Fig. 5
Cut surface of the excisional biopsy
Fig. 6
A histological section showing nodules of bland smooth muscle cells forming leiomyomas in the anorectal tissue. H&E stain (×40 magnification)
Fig. 7
Cells are uniform, without increased cellularity, nuclear pleomorphism or mitotic activity. H&E stain (×100 magnification)
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