Sonographic Appearances of Soft Tissue Angioleiomyomas

Abstract

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.

Ultrasonographic Findings of Subcutaneous Angioleiomyomas in the Extremities Based on Pathologic Subtypes

“…The ultrasonographic findings of angioleiomyoma are well-established in the literature and include an oval shape, a well-defined margin, a homogeneous echotexture, hypoechogenicity, and moderate or high vascular density ( 3 5 10 ). In our study, angioleiomyomas were also frequently well-defined, oval-shaped, homogeneous, and hypoechoic.…”

“…Rich hypervascularity with diffusely scattered irregular vessels is commonly observed in non-subungual glomus tumors ( 1 3 9 11 ). In the series reported by Park et al ( 3 ), a specific tumor vascular pattern (several clustered linear vessels that converged at a single point) was a statistically significant finding for angioleiomyoma among hypervascular masses (hemangioma and non-subungual glomus tumor) as based on color Doppler imaging. In the English literature published to date, there are no reported specific sonographic features or differential diagnostic clues for atypical imaging features of angioleiomyomas, such as isoechoic masses with little vascularity.…”

“…These tumors clinically manifest as small, movable, and painful subcutaneous masses that most commonly occur in the lower extremities. These masses are more likely to occur in females, and their peak incidence is between the fourth and sixth decades of life ( 2 3 ).…”

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

“…The most common presentation of ALM is a painful, solid, solitary subcutaneous nodule. It is mostly encountered in females in their second to sixth decade of life [ 4 ]. These lesions are slow growing and may take 10–15 years for patients to seek medical attention for the mass [ 5 , 6 ].…”

Successful Removal of Angioleiomyoma with Ultrasonographic Evaluation

“…They demonstrated that the typical sonographic features of angioleiomyoma may include an oval shape, well-defined margins, a homogenous structure, and hypervascularity. By contrast, some studies reported that angioleiomyoma may show low or moderate vascular density 3 4 .…”