Giant Angioleiomyoma in Extremity: Report of Two Cases

Abstract

Angioleiomyomas are smooth muscle tumors that occur most often in the extremities and are usually less than 2 cm in diameter. We present 2 case reports of giant angioleiomyoma. Case 1 was a 51-year-old woman with a 5-year history of a slowly growing mass 12×10 cm in diameter in the right posterior thigh. The tumor was larger than any previously reported. Case 2 was a 72-year-old man with an 8-year history of a slowly growing mass 6×6 cm in diameter in the left palm. The tumor was unique in that it grew to a giant size in the hand of the elderly patient. Magnetic resonance imaging of both cases conˆrmed the tumors' presence in the subcutis. T 1 -weighted images showed homogenous signal isointense to muscle. On T 2 -weighted images, areas of hyperintensity and hypointensity intermingled. Three-dimensional gadolinium-enhanced magnetic resonance angiography showed rapid initial enhancement followed by a gradual increase in enhancement, suggesting that the tumors were rich in vessels. Microscopic examination revealed numerous vascular channels embedded within a huge smooth muscle component.

Calcified angioleiomyoma of foot arising from the posterior tibial artery

“…Moreover, we were able to detect that the feeding artery was the medial plantar artery. Nagata et al [14] reported noncalcification, two cases in which the feeding artery was found by threedimensional magnetic resonance angiography.…”

A rare case of leiomyoma over the nose

“…Many are tender to palpation. Leiomyoma occurs predominantly on the lower extremities, less commonly on the head or trunk, and rarely on the hands or in the mouth [4][5][6]. Leiomyomas generally are asymptomatic.…”

Angioleiomyoma of Distal Ulnar Artery of the Hand

“…Most angioleiomyoma located in the hand do not show direct relationship to arteries, and only few tumors involving arteries have been reported so far [1,2,[11][12][13]15]. There are no specific imaging techniques for angioleiomyoma, but there are reports of 3D CTA imaging [15] and 3D MRI [12] being performed before surgery to help clinicians understand exactly the relationship between a angioleiomyoma and the involved arteries. In the current case, preoperative 3D CTA clearly showed the mass involving the ulnar artery and MRI defined its relationship with adjacent structures (Fig.…”

“…The usual treatment for patients having symptoms similar to those in our case is simple excision of the mass and ligation of the feeder vessels [12]. Adequate collateral circulation should be verified both before and during the operation.…”

“…They originate from the tunica media layer of vessel walls and are uncommon in the hand [3]. The majority of these tumors in the hand had been reported as arising from the veins [5]; only few cases have been reported as arising from the arteries in the hand [1,2,[11][12][13]15]. The rarity of the condition may, in fact, result from incorrect diagnoses.…”