We encountered a patient with primary cervical leiomyoma with remarkable calcification and ossification. A 68-year-old man presenting with induration and swelling of the left submandibular region was found to have nodular lesions with calcifications in the left submandibular region and the upper mediastinum on CT. Fine needle aspiration biopsies (FNAB) of the left submandibular lesion revealed no malignancy. Resection was performed for definitive diagnosis and treatment. The resected specimen contained a solid tumor, which was markedly calcified and ossified on the cut surface. Histopathological examination showed proliferating spindle cells in a tangled and crossed arrangement. Immunohistochemically, the spindle cells were stained intensely with -SMA and h-caldesmon, consistent with smooth muscle cells. These findings led to a definitive diagnosis of leiomyoma with calcification and ossification. This is extremely rare and the preoperative differentiation from other tumors of the head and neck was very difficult. By resection of the submandibular tumor, both definitive diagnosis of leiomyoma by histopathological and immunohistochemical analyses and treatment could be carried out. However, as the tumor in the upper mediastinum was most likely to be leiomyoma with calcification, he did not wish to undergo its biopsy and resection immediately. We have continued the follow-up. 1. Introduction Leiomyoma is a benign and nonepithelial tumor that commonly arises from the uterus, esophagus, and skin. Primary leiomyomas of the head and neck account for 12% of all leiomyomas [1] and a very small percentage of all head and neck tumors. They are usually solitary, rounded, and well-demarcated masses, but primary cervical lesion with calcification and ossification is extremely rare. It is not clear that calcification and ossification are strongly suggestive of benignancy. In particular, the differentiation between leiomyoma and leiomyosarcoma is very important but often difficult at the preoperative stage [2–4]. Histopathological and immunohistochemical analyses after surgery are necessary for the definitive diagnosis of leiomyoma. Here, we report a rare case of primary cervical leiomyoma with remarkable calcification and ossification, with a review of the literature. 2. Case Report The patient was a 68-year-old man presenting with induration and swelling of the left submandibular region. His past medical history and familial history were unremarkable. At the age of about 25 years, he had noticed a small induration with an irregular surface in this region, but it was
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