Angioleiomyoma: a rare diagnosis of a painful subcutaneous nodule in the hand

Abstract

Angioleiomyoma of the hand is a rare differential diagnosis of painful soft tissue nodule in the extremity. It arises from smooth muscle of the blood vessels and the most common symptom is pain. Imaging with magnetic resonance imaging shows characteristic features like a hypodense peripheral capsule with linear or branching internal hyperdensities on T2-weighted images, and post-contrast diffuse homogenous enhancement with a vessel leading up to the lesion. Histopathological examination shows well circumscribed fascicles of mature smooth muscle cells surrounding vascular lumina, lined by normal appearing endothelium without elastic lamina present. These cells stain positive for smooth muscle actin, desmin, vimentin, type IV collagen and S100, but stain negative for HMB-45 and ER. Angioleiomyoma is amenable for surgical resection. We report a case of painful subcutaneous nodule of hand, with radiological and histopathological findings suggestive of angioleiomyoma. We outline the clinical, radiological and histopathological features of this rare diagnosis for painful nodule of extremity.

A Rare Case of Angioleiomyoma of the Hand

“…Hand involvement by angioleiomyoma is extremely rare due to paucity of smooth muscles in vasculature of the hand [2]. Epidemiologically, females are affected more than males with a ratio of 1.7:1, but upper extremity involvement was reported to be more common in males, as in the case of our patient [3,4]. Multiple theories regarding the etiology of angioleiomyoma have been proposed in the literature, including minor trauma, hamartomatous changes, venous stasis and hormonal imbalance [1,3].…”

“…Pain is the most common presenting complaint, occurring in 60% of cases [1,3,4]. The pain is thought to be a result of stretching of the nerves in the capsule of tumor, vasoconstriction giving rise to local ischemia or due to release of chemical mediators from mast cells [3,4]. They have an insidious growth over many years ranging from five to seven years in one study before the initial presentation [3].…”

Angioleiomyoma within the first intermetatarsal space of the foot

“…They usually arise in females between 30 and 60 years of age, and are also referred to as angiomyomas or vascular leiomyomas. 8 They usually present as uncomfortable slow-growing solitary nodules within an extremity, [9][10][11][12][13] but there have been reports of angioleiomyomas in the nipple, hard palate, labia majora, pinna, and sella. 8 They are painful in 60% of cases, probably due to the stretching of nerves within the tumour, or the release of mast cell mediators.…”

“…8 They usually present as uncomfortable slow-growing solitary nodules within an extremity, [9][10][11][12][13] but there have been reports of angioleiomyomas in the nipple, hard palate, labia majora, pinna, and sella. 8 They are painful in 60% of cases, probably due to the stretching of nerves within the tumour, or the release of mast cell mediators. 8,12 Differential diagnoses of angioleiomyomas may include glomus tumours, neuroma-bursa complexes, ganglions, eccrine spiradenomas, and angiolipomas.…”

“…8 They are painful in 60% of cases, probably due to the stretching of nerves within the tumour, or the release of mast cell mediators. 8,12 Differential diagnoses of angioleiomyomas may include glomus tumours, neuroma-bursa complexes, ganglions, eccrine spiradenomas, and angiolipomas. 8,13,14 All of these are treated via surgical excision and they do not appear to reoccur.…”