<Case Report>Leiomyomatosis in pelvic lymph nodes : case report and differential diagnoses

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Leiomyomatosis in pelvic lymph nodes is rare. We report a case of leiomyomatosis in iliac lymph nodes in a woman with keratinizing epidermoid carcinoma of the cervix. A 39-year-old married Japanese female, who had a history of received hormonal therapy, visited the Department of Obstetrics and Gynecology at Kinki University Hospital on July 14,1993,with bloody discharge. Colposcopy and biopsy suggested squamous cell carcinoma (keratinizing type) of the cervix. A radical hysterectomy and bilateral salpingo-oophorectomy with pelvic lymph node dissection was performed on August 6,1993. At the time of operation, the peritoneal cavity was free of neoplastic dissemination and the peritoneal lymph nodes were normal size. Histopathological examination showed a keratinizing epidermoid carcinoma of the cervix, and intramuscular leiomyoma nodule (0.5 cm in diameter) was detected in the fundus of the uterus. Histopathologically, this was a typical benign leiomyoma. The right ovary showed a serous cystadenoma, and the left ovary showed hemorrhagic corpus luteum. The lymph nodes were free of neoplasms, however, bilateral iliac lymph nodes were enlarged to soybean-showed size, and microscopically, a large amount of well differentiated smooth muscle tissue. Immunohistochemical investigation showed a positive reaction for smooth muscle actin and desmins in the spindle cells that had proliferated in the lymph nodes ; no cytokeratin positivity was detected.