An uncommon cause of lower leg pain

Abstract

A 63-year-old woman was referred to dermatology by her primary care provider (PCP) for a skin lesion on her right leg that had been persistently painful for 7 years.History The patient described the lesion as painful and tender but said that the pain did not radiate. She reported a burning sensation at the lesion. She rated her pain a 9 out of 10 the day of her dermatology appointment. She said that any touch of even the lightest pressure to the skin lesion caused her pain, including water running down her leg while showering.The patient is a retired middle-school teacher. Over the past 7 years, she has had numerous evaluations and examinations performed by her PCP, a dermatologist, and a neurologist. Her neurology appointment included a noncontrast MRI of her head, which revealed no abnormalities.The patient said she was frustrated and perplexed, as she was still without any improvements to or resolution of the painful lesion. She denied lesion growth or new appearances elsewhere. She also denied fever, thyroid dysfunction, immunosuppression, leg discoloration, leg cramps, leg swelling, lower extremity numbness, tingling, or varicose veins. Her past medical history included arthritis and untreated hypertension. She takes over-the-counter supplements, such as vitamin D, calcium, and fi sh oil, on a routine basis. Her family history was noncontributory.

Association of Magnetic Resonance Imaging Features with Angioleiomyoma Histologic Subtype

“…Angioleiomyomas are difficult to diagnose preoperatively. The tumors may not be recognized as the cause of pain for a long time, because the severity of the pain is disproportionate to their size 3 . Differentiating angioleiomyomas from other painful soft tissue tumors based only on clinical findings is difficult 4 .…”