Angioleiomyoma mimicking a swollen bursa on first metatarsophalangeal joint accompanying with hallux valgus deformity

We present a case of a patient who underwent a modified scarf osteotomy and tumour excision based on a preoperative diagnosis of hallux valgus deformity and accompanying bursitis. Subsequent histopathological examination revealed that the tumour was an angioleiomyoma. While tumours around the first metatarsophalangeal (MTP) joint are typically associated with gouty nodules, infections, or swollen bursa (bursitis) in patients with hallux valgus deformity, the occurrence of soft tissue tumours in this area is rare. Moreover, angioleiomyoma is an even rarer form of soft tissue tumour and is seldom suspected prior to resection. To our knowledge, there have been no reports of angioleiomyoma arising in the first MTP joint. However, it is important to consider the possibility of an atypical tumour in cases where soft tissue masses are present, even in patients with hallux valgus deformity, and to perform at least imaging tests such as ultrasound and magnetic resonance imaging before surgery. This prospect should always be kept in mind.

Primary Intracranial Angioleiomyoma: A Case Report and Literature Review

BACKGROUND

Angioleiomyoma is a benign soft tissue tumor that manifests as pain and is more common in the extremities. However, primary intracranial angioleiomyoma is an extremely rare entity that is poorly characterized clinically, radiologically, and histopathologically. We compiled and examined reported cases of intracranial angioleiomyoma to provide an up-to-date summary of the condition. A literature search was performed using PubMed with specific key terms. Selected case studies and case series were then compared, and statistical analyses were performed where appropriate.

CASE DESCRIPTION

A 59-year-old woman presented with epileptic seizures and a 2-month history of progressive headache. Magnetic resonance imaging of the brain revealed a right temporal pole tumor near the right cavernous sinus. Gross total resection was performed. Histopathologic and immunohistochemical examination demonstrated an angioleiomyoma. No adjuvant radiation or chemotherapy was administered. Magnetic resonance imaging of the brain performed at 6-month follow-up showed no signs of recurrence.

CONCLUSIONS

Primary intracranial angioleiomyoma is an exceedingly rare central nervous system tumor. The clinical and radiologic manifestations are nonspecific. The diagnosis depends on the histopathologic and immunohistochemical examination. For patients with clinical symptoms, surgical resection should be the first-choice treatment.

Subcutaneous nasal angioleiomyoma: Case of a rare tumor and review of the literature

We describe the case of a 46-year-old woman with a rare presentation of angioleiomyoma of the subcutaneous nasal tissue. The patient presented with pain and severe nasal obstruction. Her nasal deformity was sufficient to indicate an external rhinoplasty for both extirpation of the tumor and reconstruction of the defect with cartilage grafts. The procedure resulted in successful removal of the tumor and a satisfactory cosmetic outcome.

Large pedunculated angiomyofibroblastoma of the vulva with concomitant anemia: a case report and mini review of the literature

Angiomyofibroblastoma is a rare myxoid tumor and is often seen in vulvar and vaginal area. Patients usually present with a mass on the vulva or labium majus at the premenopausal ages. The lesions are usually between 0.5 cm and ten cm. Lesions have quite cellularity with regular borders under the microscope. Lesions contain numerous veins and bulging stromal cells. Treatment of angiomyofibroblastoma is simple surgical resection. Angiomyofibroblastoma should be differentiated from the other vulvar neoplasms, which need radical surgical treatment, especially from the aggressive angiomyxoma. Hereby, the authors aimed to report a premenopausal women presented with vulvar mass and accompanying anemia. She was diagnosed with angiomyofibroblastoma.

Uterine angioleiomyoma causing severe abnormal uterine bleeding

BACKGROUND

Angioleiomyoma or angiomyoma or vascular leiomyoma is an unusual benign mesenchymal neoplasm. The authors present a rare case of large uterine angioleiomyoma causing severe abnormal uterine bleeding.

CASE

The patient, a 53-year-old, gravida 2, para 2, premenopausal Greek woman presented with a complaint of severe abnormal uterine bleeding. On gynecologic examination there was a palpable pelvic mass. Preoperative computer tomography (CT) of the abdomen and pelvis revealed an intra-abdominal mass 25 x 15 cm with abnormally increased vascularization. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, total omentectomy and elective pelvic lymph node dissection. Histopathology revealed uterine angioleiomyoma. Follow up 84 months after initial surgery showed no evidence of recurrence.

CONCLUSION

Despite the type of surgery, patients with uterine angioleiomyoma have very low risk of recurrence and excellent prognosis.

Sonographic appearances of soft tissue angioleiomyomas: differences from other circumscribed soft tissue hypervascular tumors

OBJECTIVES

The purpose of this study was to evaluate the sonographic features of angioleiomyomas with priority given to the vascular pattern to help in the differential diagnosis from other hypervascular soft tissue tumors.

METHODS

The inclusion criteria for this retrospective and nonblinded study were fulfilled in 33 patients with circumscribed hypervascular soft tissue tumors based on pathologic identification. Thirteen cases were angioleiomyomas; 9 cases were nonsubungual glomus tumors; and 11 cases were hemangiomas. Two musculoskeletal radiologists interpreted the results by consensus. Sonographic findings, including the shape, size, echogenicity, vascular pattern, and vascular density of the angioleiomyomas, were compared with those of the other hypervascular tumors. Vascular patterns were categorized into 3 vascular types: 1, several linear vessels clustered in the tumor with convergence to one point; 2, diffusely scattered irregular vessels in the tumor, and 3, one or more vessels that were centrally located. The vascularity of the mass was also categorized as rich (covering >50% of the area of the lesion), moderate (between 20% and 50%), and little (<20%).

RESULTS

All of the angioleiomyomas were hypoechoic (100% [13 of 13]), a statistically significant result (P = .001). The type 1 vascular pattern was observed in 69% of the angioleiomyomas (9 of 13; P = .029), and the statistically significant shape was round (38% [5 of 13]; P = .035).

CONCLUSIONS

Most angioleiomyomas reveal a homogeneously hypoechoic echo texture with a circumscribed margin and show straight and linear vessels in the tumor with convergence to one point on color Doppler sonography. These characteristics may be helpful when differentiating angioleiomyomas from other circumscribed hypervascular soft tissue tumors.

[Angioleiomyoma utery in a female patient with damaged health condition. Diagnostic and terapeutic difficulties]

35 years old patient with many health problems, on a haemodialysis and a big abdominal tumor originating from the pelvis. The authors share their clinical approach and their diagnostic and terapeutic difficulties in this case and refer to one of their previous publications.

Toothache induced by an angioleiomyoma of the nasolabial groove: a case report

Angioleiomyoma, a benign soft tissue tumor composed of smooth muscle cells and vascular endothelium, occurs most commonly in the extremities, the lower leg being a common site of occurrence. It rarely is found in the head and neck area, especially in the nasolabial groove. Surgical excision is the gold standard for diagnosis and treatment of angioleiomyoma; a preoperative diagnosis may be difficult. Here, a case of angioleiomyoma found in the nasolabial groove and associated with toothache is presented.

Recurrent vascular leiomyoma of the larynx: clinical and histopathologic characteristics and treatment

Laryngeal vascular leiomyomas are uncommon benign tumors that seldom recur following complete excision. The choice of excision procedure-via direct laryngoscopy or an open approach-is dictated by tumor size, the expected amount of blood loss, and any comorbidities the patient may have. We report an unusual case of a recurrent laryngeal vascular leiomyoma in a 64-year-old woman who also had a concurrent parathyroid adenoma and a history of breast carcinoma. A surgical resection via an external approach along with laser resection of a small glottic component was needed.

Vascular leiomyoma resulting in ulnar neuropathy: case report

We report a case of vascular leiomyoma arising from the distal ulnar artery in the palm that revealed symptoms similar to those of Guyon's canal syndrome.

[Case of Carney complex complicated with pituitary adenoma and Rathke cleft cyst]

Carney complex is a rare autosomal-dominant, familial tumor syndrome first described in the mid 80's. This syndrome is multiple neoplasia syndrome featuring cardiac, endocrine, cutaneous, and neural tumor, in addition to a variety of pigmented lesions of the skin and mucosa. We report the case of a 12-year-old female patient with Carney complex who manifested a high value of serum growth hormone (s-GH), cutaneous angiomyxomas and labial pigmented lesions. Magnetic resonance imaging (MRI) revealed a cystic pituitary tumor. We carried out removal of the pituitary tumor via the transsphenoidal approach. In addition to the pituitary adenoma, pathological examination revealed the presence of a Rathke cleft cyst. So far, approximately 500 cases of this disorder have been described, but there have been no cases similar to our case described here. Therefore, the present case seems to be the first case of Carney Complex complicated with pituitary adenoma and Rathke cleft cyst.

Leiomyoma of the uterus and retroperitoneal angioleiomyoma: case report

Retroperitoneal angioleiomyoma is a benign mesenchymal neoplasm that is composed of smooth muscle cells and thick-walled vessels. In a 36-year-old patient a retrouterine and retroperitoneal tumor, 70 x 65 x 50 mm in size, was discovered during a surgical procedure due to uterine myoma. The tumor had a soft consistency and was completely removed. Histopathology showed features of angioleiomyoma. Angioleiomyoma is a rare benign entity; hence a benign course and good prognosis are expected.

Angioleiomyoma of the internal auditory meatus: a rare occurrence in the internal auditory canal

We describe a case of angioleiomyoma of the internal auditory meatus. A finding of this tumor at this site is very unusual. In fact, our review of the literature revealed that only 1 case has been previously reported. In our patient, the tumor was clinically and radiologically difficult to distinguish from an acoustic neuroma. It would be important to recognize this rare small tumor preoperatively because it may be appropriate to manage it conservatively.

[Obstructive urethral angioleiomyoma]

OBJECTIVES

To report one case of urethral angioleiomyoma because of the rare site, and to review its main characteristics.

METHODS

We report one case of male urethra angioleiomyoma presenting with obstructive symptoms.

RESULTS

We performed excision and end to end anastomosis of a small bulbar urethra stenosis. Pathology reported angioleiomyoma.

CONCLUSIONS

Angioleiomyoma is a benign tumor arising from smooth muscle within blood vessel walls. It is extremely rare in the urethra. It is more common in females. Recurrence and metastasis are exceptional. It shows scarce or moderate cellularity with predominance of fusiform cells. They may express smooth muscle vimentin, desmin, and actin. The best therapeutic option is resection.

Multiple uterine angioleiomyomas in a woman presenting with severe menorrhagia

BACKGROUND

Angioleiomyoma is a rare benign neoplasm that originates from smooth muscle cells and contains thick-walled vessels. There were only five cases of uterine angioleiomyoma reported in the available English literatures. We present here the unique computed tomography finding in a patient with multiple uterine angioleiomyomas causing severe menorrhagia.

CASE

A 50-year-old, nulligravid woman consulted us with the complaint of menorrhagia for 3 years and progressively palpable lower abdominal mass for a half year. Laboratory findings were all within normal limits except lower hemoglobin concentration (6.2 g/dl). An abdomino-pelvic computed tomography (CT) showed that a huge 30-cm heterogeneously multilobulate mass with solid and laminated configuration, with cystic and multiseptal contents was found in left lower abdomen and pelvic cavity. At laparotomy, the area beneath the left broad ligament was filled with a well-encapsulated, elastic, ovoid, and lobulate mass that connected to the uterus and measured up to 20 cm in greatest diameter. The uterus was composed of a huge intramural tumor and measured 28 x 21 x 12 cm. The uterus and huge subserosal tumor were resected completely and a frozen section was obtained. The final histopathologic diagnosis was angioleiomyoma, a definitely benign soft tissue tumor. Eighteen months after surgery there was no recurrence.

CONCLUSION

Uterine angioleiomyoma should be considered when prominent tortuous vascular-like enhancing structures are noted on CT examination of a well-demarcated soft tissue mass arising from the uterus in pelvis. Either angiomyomectomy with tumor-free margins or hysterectomy proved to be an effective treatment in these cases, and resulted in a good recovery and a satisfactory outcome.

Vascular leiomyoma presenting as medial joint line pain of the knee

We present the case of a 27-year-old woman with a subcutaneous vascular leiomyoma occurring around the knee. The patient presented with a several-year history of medial-sided knee pain with an unknown etiology. The clinical presentation, magnetic resonance imaging, and histopathologic features are reported, and the literature pertaining to the clinicopathologic characteristics is reviewed. By including vascular leiomyomas in the differential of painful lower extremity subcutaneous masses, an early accurate diagnosis is possible.

[Rare palate tumors: treatment and results]

8 patients (7 male and 1 female) treated between 1991-1998 in Szczecin centre due to the tumours different than carcinoma planoepithelial of the palate were presented. Their age ranged from 30 to 81 years. The dimension of the tumour ranged from 1 to 5 cm. The diagnosis of those tumours was: adenoid cystic carcinoma--2 cases, rare (unnamed) tumour of low malignancy probably of salivary gland origin--1 case, cystis lined with cylindrical epithelium--1 case. 7/8 patients were treated by surgery and in 3 cases RTG therapy followed surgery. One patient refused the treatment. 6/8 patients are alive. One patient died 2 years after surgery. There is no information about the one, who wasn't operated on. 3 patients remain without complains. 3 developed rhinolalia aperta and one from them (following RTG therapy) complain of dryness in the oral cavity. None from the operated on reports any swallowing problems.

[Angioleiomyoma of the gallbladder: a rare cause of hemobilia in a patient on dialysis]

HISTORY AND FINDINGS

Acute colicky upper abdominal pain occurred in a 47-year-old man on renal dialysis who also had chronic recurrent pancreatitis. On physical examination he was noted to be slightly jaundiced and he had slight pain when the liver edge was palpated. A few days later melaena developed and the haemoglobin concentration fell from normal levels to 6.9 g/dl.

INVESTIGATIONS

Serology gave no evidence of acute pancreatitis, but biochemical tests indicated cholestasis. Ultrasonography revealed widening of the intra- and extrahepatic biliary tract. Endoscopic retrograde cholecystopancreatography demonstrated bleeding from the biliary tract (haemobilia) as the source of the bleeding. Selective angiography of the coeliac trunk showed extravasation in the region of the gallbladder.

TREATMENT AND COURSE

As a vascular anomaly in the gallbladder was suspected, a cholecystectomy was performed. The surgical specimen revealed an angioleiomyoma of the gallbladder. The postoperative course was without complications and there was no further haemobilia.

CONCLUSIONS

Haemobilia is a relatively rare cause of upper gastrointestinal bleeding. It is usually due to trauma (accidental or iatrogenic) to the liver or the biliary tract. Rarely, as in this case, it can be caused by a benign mesenchymal neoplasm. Clotting disorder in uraemia or intermittent heparin administration for dialysis may in this patient have contributed to the bleeding.

Gaze-evoked amaurosis heralding orbital angiomyoma. Case report

The unusual case of a patient presenting with gaze-evoked amaurosis as an early and isolated sign of orbital angiomyoma is reported. Computed tomography or magnetic resonance of the orbits need to be expeditiously performed in patients with gaze-evoked amaurosis in order to identify or rule out the possible presence of an underlying tumor.

Intravenous leiomyomatosis complicated by Budd-Chiari syndrome

A 76-year-old woman with intravenous leiomyomatosis complicated by Budd-Chiari syndrome is described.

Angioleiomyoma involving the sciatic nerve--CT demonstration. Case report

An angioleiomyoma adjacent to the sciatic nerve was responsible for an 11-year history of pain and dysfunction in the sciatic nerve distribution, which required numerous therapeutic procedures and intermittent use of narcotic analgesics. Diagnosis was finally made when results of a sciatic nerve block suggested possible mechanical compression of the nerve and computed tomography examination of the pelvis was extended further caudal than usual, demonstrating the tumor adjacent to the sciatic nerve near the ischial tuberosity. Only one previous case of nerve dysfunction due to impingement by an angioleiomyoma has been reported.