Clinical and Sonographic Evaluation of a Lower Extremity Angioleiomyoma in a 52-Year-Old Woman

Abstract

Objective: The purpose of this case study is to describe the role of sonographic examination in the initial evaluation of an angioleiomyoma and to discuss the characteristic findings associated with this soft tissue mass. Clinical Features: A 52-year-old woman presented with a large, tender, erythematous mass on the anterolateral aspect of her right knee. Sonographic examination revealed a highly vascular mass within the subcutaneous tissues. Differential considerations included benign soft tissues masses such as angioleiomyoma and hemangioma. Intervention and Outcomes: Surgical consultation was recommended. Excisional biopsy was performed. Histopathological examination confirmed the diagnosis of angioleiomyoma. Conclusion: Although ultrasonographic findings of a superficial soft tissue mass may be nonspecific, when a highly vascular, well-defined, slow-growing mass is present, angioleiomyoma should be included in the differential diagnosis.

An uncommon cause of lower leg pain

“…1 It is slowgrowing, generally less than 2 cm in diameter, more common in women, presents in patients ages 10 to 59 years, and most commonly presents on the lower extremities. 1,2 The tumor can be dermal, subcutaneous, or may occur in extraskeletal sites or the superfi cial fascia of the extremities, and produces pain in up to 60% of patients. [2][3][4] The pain often is reported as spasmodic and initiated by light touching, exposure to wind or cold, and other environmental stimuli.…”

“…1,2 The tumor can be dermal, subcutaneous, or may occur in extraskeletal sites or the superfi cial fascia of the extremities, and produces pain in up to 60% of patients. [2][3][4] The pain often is reported as spasmodic and initiated by light touching, exposure to wind or cold, and other environmental stimuli. 1,5 The pain most patients experience is thought to originate from smooth muscle contraction that produces local ischemia.…”

“…1,5 The pain most patients experience is thought to originate from smooth muscle contraction that produces local ischemia. 1,2 An additional study has revealed pain may be mediated through nerve fi bers within the tumor parenchyma. 1 The three subtypes of angioleiomyoma are: • Solid, the most common type, which is composed of smooth muscle bundles that surround the vascular channels and interfere with these vessels.…”

Angioleiomyoma of the Extremities: Findings on Ultrasonography and Magnetic Resonance Imaging

“…Hirata el al reported that the origin of the angioleiomyoma was not the smooth muscle of an artery but the smooth muscle of a vein because the capsule of the tumor was contiguous with the adventitia of the vessel, which did not contain the internal and external laminae. Moreover, Smith et al reported that a large superficial vein was located in the proximity of an angioleiomyoma, and Mattox et al reported that a large draining vessel was observed inferior to the angioleiomyoma on US. On the basis of these findings, we hypothesize that angioleiomyomas arise from the smooth muscle cells of veins' walls located in the soft tissue in the extremities; therefore, hypoechoic protrusions can be observed on one or both ends.…”

Inguinal canal angioleiomyoma: case report of a rare disease entity within inguinal canal

“…In ALM, ultrasound examination shows well-defined margins and a homogenous structure, suggestive of benign nature of the lesion [ 8 ]. High resistance in intra-tumor arteries, which suggests the presence of muscular arteries, is the feature of angioleiomyomaon Color Doppler examination [ 9 ]. MRI scan was done in this patient rather than a computed tomography (CT) scan as it shows better resolution and soft tissue differentiation.…”