Angioleiomyoma of the upper extremity

Angioleiomyoma - A Case Report

Angioleiomyoma is a rare benign soft tissue tumour arising from smooth muscle, representing <1% of upper limb soft tissue tumours. We report a 54-year-old male presenting with a progressively enlarging atraumatic lesion along the palmar side of the base of the ring and little finger. A biopsy was done to determine the diagnosis. Intraoperatively, the lump was found to be intimately related to the radial digital artery, it could not be excised en-bloc without transecting the radial digital artery of the little finger. Following excision, the ends of the digital artery were anastomosed. At 10-months follow-up, the hand was fully functional without any evidence of cold-intolerance or neurological deficit along the distribution of the digital nerve. We review the literature on angioleiomyoma and report careful resection of the tumour with digital artery transection and repair as a treatment option for angioleiomyoma of the digital artery. Level of Evidence: Level V (Therapeutic).

Benign Hand Tumors (Part II): Soft Tissue Tumors

Background: Benign soft-tissue tumors of the hand are more common than both their benign bone and malignant soft-tissue counterparts. This study evaluates the characteristics and treatment of benign soft tissue tumors in light of 1 institution's experience. Methods: Histologically confirmed benign soft-tissue tumors of the hand were retrospectively identified using International Classification of Disease codes from 1992 to 2015. A medical chart review was conducted to collect patient demographics, tumor epidemiology, and treatment. Results: A total of 199 soft-tissue tumors were identified. The median patient age at time of treatment was 47.4 ± 14.7 years in age. The majority of tumors were located in the digits (n = 168, 84%) and treated by excision (n = 191, 96%). Localized type tenosynovial giant cell tumors (n = 71, 36%) were the most common and had the highest rates of recurrence (8.5%) in this series. Other frequent histologies included hemangioma, schwannoma, and glomus tumors. Conclusion: Awareness and understanding of tumor characteristics may help physicians with diagnosis and treatment. There is an extensive variety of tumors, but the principles of clinical and imaging diagnosis are common to all of them. Marginal excision for the treatment pain, improvement of function, and cosmetic correction applies to all these tumors independent of the histology.

Angioleiomyoma of the hand with nerve compression

Objective

This study was performed to analyze the clinical, radiographic, and pathological features of hand angioleiomyoma causing nerve compression and assess the outcomes of surgical excision.

Methods

This case series included three men and one woman (mean age, 53.3 years; range, 49–56 years). The patients’ chief complaint was numbness of the fingers. The patients’ medical histories were reviewed, and the diagnosis of angioleiomyoma with nerve compression was confirmed by means of imaging examination and pathological analysis.

Results

Three tumors occurred in the palm and one in the finger, and the average maximum tumor diameter was 1.8 cm (range, 0.8–2.6 cm). Preoperative magnetic resonance imaging demonstrated well-defined masses with isointense signals on T1 sequences, hyperintense signals on T2 sequences, and strong heterogeneous enhancement after injection of contrast material. All tumors were located near nerves, leading to nerve compression. The diagnosis of angioleiomyoma was confirmed by postoperative pathology. Finger sensation recovered and no recurrence was found during an average follow-up of 37 months (range, 25–59 months).

Conclusions

Angioleiomyoma should be considered among the differential diagnoses of hand tumors and timely resection should be performed, particularly if the mass is causing numbness and/or pain with positive Tinel’s sign and/or tenderness.

Angioleiomyoma of the Hand: A Case Series and Review of the Literature

Background

Angioleiomyomas are rare tumors arising from vascular tissue that can occasionally present in the hand. Reports of angioleiomyomas in this location are highly limited. Here, we describe the presentation and outcomes of a series of cases of angioleiomyomas.

Methods

A retrospective case review of five patients with angioleiomyomas arising in the hand was performed. Patients were identified via International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) diagnosis codes and were reviewed through the electronic medical record for demographic information, tumor characteristics, management, and outcomes. A literature review was also conducted of angioleiomyomas.

Results

Five patients were diagnosed with angioleiomyoma at our institution between 1992 and 2015. Patients presented with a painful, slow-growing hand mass in all cases. The majority of patients were male and of middle-age. All of the patients were successfully treated with marginal excision and had full return to functional status without recurrence.

Conclusion

Angioleiomyomas are rare tumors that can arise in the hand and should be included in the differential diagnosis of a patient presenting with a painful hand mass. They can be successfully treated with marginal excision.

Angioleiomyoma of the proper ulnar digital artery: Case report

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Angioleiomyoma is a rare benign tumor comprised of smooth muscle cells.

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Other than biopsy, no modality of investigation can conclude the diagnosis.

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Favorable prognosis can be obtained by simple local excision.

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This case report presents a condition in which this tumor emerged from hand’s artery - An extraordinary observation.

Introduction

With the rarity and benign nature, angioleiomyoma is a tumor of disputed etiology that originates from the tunica media of the blood vessels. Lacking any characteristic clinical or radiological features, often leading to preoperative misdiagnosis, it is only diagnosed confidently on the basis of histopathology; for this reason combined with the rarity, angioleiomyoma would not be usually found at the top of the differential diagnosis list. Local excision is usually curative with excellent prognosis.

Case

This report discusses a case of a 60-year-old healthy lady who complained of a chronic painless mass in the right 2nd digit. Originating from the proper ulnar digital artery, it was excised with no complications. Histopathology results confirmed the diagnosis of angioleiomyoma. No recurrence was observed 6 months following the procedure.

Discussion

Out of the handful published papers concerned with angioleiomyoma in hands, few report the origin to be the digital artery.

Conclusion

Further awareness about this tumor is required and it should be included in the differential diagnoses list of the treating surgeon.

Primary Hand Leiomyoma: A Systematic Review

BACKGROUND

Primary leiomyoma is a rare cause of a mass in the hand, with few reported cases to date. To our knowledge, this constitutes the most comprehensive and up-to-date systematic review of the literature of all cases of primary hand leiomyoma. We also provide an additional case recently managed in our practice of confirmed primary vascular leiomyoma of the hand in a 44-year-old woman to add to the current body of literature.

METHODS

We performed a comprehensive literature review of all articles published on primary leiomyoma of the hand. The PubMed database was used, with search terms leiomyoma hand, angioleiomyoma hand, and angiomyoma hand. Articles were selected for their accuracy in anatomic localization in the hand and confirmed pathology of leiomyoma.

RESULTS

Our initial search query resulted in 216 articles. After applying the inclusion criteria, we identified 50 individual articles with 108 cases of confirmed primary leiomyoma in the hand from January 1, 1954, to July 1, 2018. Common initial clinical impressions recorded for primary hand leiomyoma included ganglion cyst, giant-cell tumor, hemangioma, and glomus tumor. Patients presenting with leiomyoma of the hand frequently describe a painful lesion, which differs from most other benign tumors of the hand at presentation.

CONCLUSIONS

Leiomyoma is an important consideration when developing a differential diagnosis for primary benign masses in the hand. We hope that this comprehensive review can provide increased awareness of this tumor type.

Pediatric Acral Angioleiomyoma: Report of an Unusual Case and Review of the Literature

BACKGROUND

Angioleiomyoma is a classic painful cutaneous tumor of the limbs of middle aged adults. They are usually a straight-forward histologic diagnosis, being well-circumscribed or encapsulated lesions with both smooth muscle and vascular components.

CASE REPORT

We report the case of an angioleiomyoma on the toe of an 8-year-old girl which displayed an unusual plexiform growth pattern. It was treated successfully with surgical excision, with no recurrence at one month.

CONCLUSIONS

Angioleiomyoma is uncommon in children, particularly at acral sites. We describe the first such lesion to display a plexiform growth pattern.

A rare tumour of hand: angioleiomyoma

Angioleiomyoma is a benign tumour composed of smooth muscle and vascular tissue. Because of the paucity of smooth muscles in the hand other than tunica media of the blood vessels, its occurrence is quite rare in the hand and only few cases are reported in the English literature. We present the case of a 49-year-old man with benign painless swelling on the dorsum of hand. Differential diagnosis of ganglion cyst and tendon sheath tumour were considered. However, excision biopsy revealed angioleiomyoma. At 2-year follow-up, the patient remained asymptomatic with no evidence of recurrence.

A Huge Angioleiomyoma of the Finger

Vascular leiomyoma is a rare soft tissue lesion in the upper limbs. We reported a case of vascular leiomyoma in a 77-year-old female. It presented with a large painless slow growing lesion in the finger, which had grown to size up to 4 × 3 cm. X-ray and MRI were performed pre-operatively. Surgical excision was performed and the histological findings confirm the diagnosis.

Leiomyoma in the thumb causing trigger finger

Leiomyoma is a generally benign tumour and common in the uterine smooth muscle. In some cases, it is found in other parts of the human body. In our study, we report the case of a 61-year-old woman with a painless cystic lesion on the first left thumb associated with trigger finger. The first diagnostic hypotheses were ganglionic cyst and giant cell tumour, however, after surgical excision and histological analysis, it was revealed to be a rare leiomyoma of the hand. We report a clinical case and detailed histopathological study, with 12 high-resolution images stained with: H&E, Smooth Muscle Actin, Desmin, S-100 and CD34.