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

Angioleiomyoma in a 54-year-old Female: A Case Report of Distal Leg Tumor and Review of the Literature

Introduction

Angioleiomyomas are rare benign tumors originating from smooth muscle cells of blood vessels. Although they can occur in various anatomical locations, angioleiomyomas of the distal leg are relatively uncommon. Due to its clinical resemblance to other soft-tissue tumors, misdiagnosis can occur leading to inadequate treatment.

Case Report

We present a case of angioleiomyoma in a 54-year-old female who presented with a palpable mass in her distal leg. The tumor was surgically excised, and histopathological examination confirmed the diagnosis of angioleiomyoma. In this article, we discuss the clinical presentation, diagnostic evaluation, and management of angioleiomyoma, with a focus on distal leg tumors. Furthermore, we provide a comprehensive review of the existing literature on angioleiomyomas, emphasizing findings and treatment outcomes reported in previous studies.

Conclusion

Angioleiomyomas are uncommon soft-tissue tumors that can mimic other more common lesions such as ganglion cysts. Hence, diagnosis requires a high index of suspicion. Surgical excision is the treatment of choice for angioleiomyoma. Complete resection is generally curative, with a low rate of recurrence.

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).

Multiloculated omental cystic tumor hiding an angioleiomyoma: case report of a rare and atypical presentation and literature review

Angioleiomyoma is a rare benign tumor arising from vascular smooth muscle and generally located in the subcutaneous tissue of the extremities. We reported a rare case of an intra-abdominal localization originating from the small omentum in which progressive growth detected on radiological follow-up indicated surgical excision. Histology documented a cavernous angioleiomuscular tumor with uncertain potential for malignancy. Although angioleiomyoma is described as a benign tumor, the uncertain behavior for malignancy of this case could have led to neoplastic degeneration. Early diagnosis followed by surgical excision of the neoplasia is crucial.

Angioleiomyoma of the Hand: A Report of Two Cases

We present a case series of two rare cases of angioleiomyoma of the hand, an infrequent type of benign tumor. In the first case, a 41-year-old female presented with a left thumb mass that had increased in size over two years. Imaging studies revealed a destructive lesion involving the first webspace with infiltration of the first metacarpal, and the mass was initially suspected to be a sarcoma. However, a percutaneous image-guided fine-needle aspiration (US-FNA) and ultrasound-guided core-needle biopsy (USG-CNB) of the left-hand mass confirmed the diagnosis of angioleiomyoma. The mass was surgically excised, and the final diagnosis was consistent with the earlier USG-CNB. In the second case, a 63-year-old man with end-stage renal disease presented for consultation regarding dialysis access creation. During the examination, a large, soft, mobile mass adjacent to the wrist on the medial aspect of his hand was identified. This was presumed to be a lipoma. However, the histopathology report revealed a benign angioleiomyoma measuring 3.2 cm, which had been completely excised during the surgery. This case report highlights the importance of considering angioleiomyoma in the differential diagnosis of soft tissue masses and the utility of US-FNA and USG-CNB in diagnosing these tumors.

An Update on Clinicopathological, Imaging, and Genetic Features of Angioleiomyoma

Angioleiomyoma is a benign, pericytic (perivascular) neoplasm that primarily occurs in the subcutis or dermis of the extremities. The lesion typically presents as a small, firm, slow-growing, painful nodule. Magnetic resonance imaging reveals the lesion to be a well-defined, round to oval mass with signal intensity similar to or slightly hyperintense to that of skeletal muscle on T1-weightwed sequences. A dark reticular sign on T2-weighted sequences appears to be a characteristic feature of angioleiomyoma. Prominent enhancement is usually seen after intravenous contrast. Histologically, the lesion consists of well-differentiated smooth muscle cells with many vascular channels. Based on vascular morphologies, angioleiomyoma is classified into three subtypes: solid, venous, and cavernous. By immunohistochemistry, angioleiomyoma is diffusely positive for smooth muscle actin and calponin and variably for h-caldesmon and desmin. Conventional cytogenetic studies have demonstrated relatively simple karyotypes characterized by one or few structural rearrangements or numerical aberrations. In addition, metaphase comparative genomic hybridization analyses have revealed recurrent loss of 22q and gain of Xq. Angioleiomyoma can be successfully treated with simple excision, with a very low recurrence rate. Knowledge of this peculiar neoplasm is important because it can mimic a variety of benign and malignant soft-tissue tumors. This review provides an updated overview of the clinical, radiological, histopathological, cytogenetic, and molecular genetic features of angioleiomyoma.