Abstract Leiomyosarcoma is a malignant tumor that
can arise from smooth muscle or from pluripotential, un-
differentiated mesenchymal cells. In the head and neck,
smooth muscle is sparse and found mainly in the walls of
blood vessels and the erector pili muscles of the skin.
The occurrence of leiomyosarcoma in the head and neck
region is rare. The purpose of this report is to describe a
case of leiomyosarcoma of the pinna. To our knowledge,
the present case is only the second case of leiomyosarco-
ma of the pinna reported.
Keywords Leiomyosarcoma · Ear · Pinna
A 90-year old man presented with a rapidly growing tumor on the
helix of the right ear. There was no history of trauma.
The mass was tender, well-circumscribed and polypoid, mea-
suring approximately 3×2 cm (Fig. 1). It was firm and fixed to the
underlying cartilage. No cervical lymph nodes were palpable and
blood parameters were normal. The tumor was removed as a full-
thickness wedge under local anesthesia.
Histology revealed highly cellular neoplastic tissue containing
interlacing bundles of spindle shaped cells with a fibrillary eosino-
philic cytoplasm (Figs. 2, 3). The nuclei were pleomorphic elon-
gated, centrally located and blunt-baton shaped with occasional
mitotic figures. Immunohistochemical studies showed positive
staining with antibodies to vimentin and anti-smooth muscle actin,
and negative staining with epithelial membrane antigen, S-100
protein, and cytokeratin. These findings were consistent with the
diagnosis of leiomyosarcoma. The patient has been tumor-free for
Approximately 3% of leiomyosarcomas develop in the
head and neck regions while 85% occur in the extremi-
ties . A study of 646 soft tissue tumors of the head
and neck region revealed only four leiomyosarcomas .
Mindell  reviewed 31 head and neck leiomyosarcoma
cases and found that the most common site was the scalp
and other superficial soft tissue regions; other common
sites of presentation were the hypopharynx, tongue, and
trachea. Only four cases of ear leiomyosarcoma have
been reported. Two cases were located in the external
auditory canal, one in the middle ear, and one on the
auricle [4,5]. The clinical features of cutaneous leiomyo-
sarcoma range from small, indolent, firm plaques and
nodules to exophytic tumors and large ulcerated lesions.
In elderly patients, cutaneous head and neck leiomyosar-
coma may mimic basal cell carcinoma, squamous cell
carcinoma, or pyogenic granuloma .
Histologically, the differential diagnoses include: des-
moplastic malignant melanoma, squamous cell carcino-
ma, atypical fibroxanthoma, plexiform schwanoma, and
O. Nahlieli (
) · Y. Shapira · B. Yoffe · A.M. Baruchin
Oral and Maxillofacial Surgery Unit, Barzilai Medical Center,
B. Yoffe · A.M. Baruchin
Faculty of Health Sciences, Ben-Gurion University of the Negev,
Eur J Plast Surg (2001) 24:42–44
O. Nahlieli · Y. Shapira · B. Yoffe · A.M. Baruchin
Leiomyosarcoma of the pinna: a case report
Received: 15 March 2000 / Accepted: 7 August 2000 / Published online: 7 November 2000
© Springer-Verlag 2000
Fig. 1 Preoperative appearance