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

Abstract

ObjectiveThe purpose of this study was to describe the ultrasonographic findings of angioleiomyoma based on pathological subtypes.Materials and MethodsThirty-nine patients with subcutaneous angioleiomyomas in the extremities were retrospectively reviewed by two radiologists and a pathologist. Sonographic images were analyzed to evaluate each tumor's anatomic location, size, shape, margin, heterogeneity, echogenicity, associated findings, and vascularity.ResultsAngioleiomyomas were divided into 3 subtypes: capillary (n = 16), venous (n = 22), and cavernous (n = 1). The one cavernous angioleiomyoma was a hypoechoic mass with rich vascularity. Hypoechogenicity was more frequently observed for venous tumors (77.3%) than for capillary tumors (43.8%), and isoechogenicity was more frequently observed for capillary tumors (56.2%) than for venous tumors (22.7%). Moderate vascularity was more frequently observed for venous tumors (59.1%) than for capillary tumors (12.5%), and little vascularity was more frequently observed for capillary tumors (62.5%) than for venous tumors (13.6%). The aforementioned findings including echogenicity (p = 0.034) and vascularity (p = 0.003) were statistically significant.ConclusionAwareness of sonographic findings of angioleiomyomas based on pathologic subtypes could be helpful for diagnosing angioleiomyoma and could increase diagnostic accuracy for superficial soft-tissue masses in our practice.

Small Subcutaneous Soft Tissue Tumors (<5 cm) Can Be Sarcomas and Contrast-Enhanced Ultrasound (CEUS) Is Useful to Identify Potentially Malignant Masses

“…Subcutaneous ST tumors are frequently observed in everyday clinical practice. US is the first-level imaging technique, accurate in identifying the more frequent benign lesions such as cysts, lipoma, bursitis, abscess, and hematoma [2,10,[12][13][14][31][32][33]. Color and power Doppler can increase the US accuracy if the radiologist holds the probe with gentle contact with the skin in order to identify small vessels [10].…”

Subtypes of Subcutaneous Angioleiomyoma on High- Resolution Color Doppler Ultrasonography along with MRI Appearances

“…Similar to intradermal nodular fasciitis (INF), as ALMs tend to occur in the subcutaneous layer, close to or in contact with dermis which contains rich capillary vessels, they show the vascular features on color Doppler US. Kim et al [5] have described the relationship between US appearances and pathologic features of subtypes in the subcutaneous angioleiomyoma in the extremities. Both venous and cavernous subtypes on gray-scale US appear as welldefined, homogeneously hypoechoic tumor, while capillary type shows well-defined, homogeneously isoechoic mass similar to the muscle.…”

“…Concerning to the color Doppler appearances, cavernous ALM represents abundant vascular flow accompanied with several feeding vessels reflecting the pathology of the dilated vascular channels with minimal smooth muscle. Venous subtype represents moderate vascular flow signal accompanied with several feeding vessels representing pathologically non-compacted smooth muscle bundles and vascular channels with thick muscular walls, whereas capillary type shows little vascular flow signal with linear feeding vessels reflecting pathologically scattered small, slit-like vascular channels surrounded by numerous compacted smooth muscle bundles [5].…”

“…Given the studies in the literature, the most of ALM are venous and capillary type. The report by Kim et al [5] suggested that capillary type is likely to show isoechoic similar to the muscle with little vascular status on gray-scale and color Doppler US due to the collapse of intratumoral vessels and a higher proportion of smooth muscle components in the mass. On the contrary, venous type is more likely to represent hypoechoic and hypervascular pattern caused by internal, thick, muscularly walled-vessels and the preservation of the vessel lumen [5].…”

“…The author has previously described the solid (or capillary) subtype of ALM as a painful and vascularized subcutaneous tumor, probably in close to the dermis [2] and indicated that all painful cutaneous and subcutaneous tumors including ALM used as the acronym "ENGLAND" or "LEND an EGG"[3], especially, angioleiomyoma, eccrine spiradenoma, schwannoma, and glomus tumor show vascularlized appearances on high-resolution color Doppler US [4]. Recently, US findings of ALM based on pathologic subtypes have been described [5] and Kang et al [6] have reported ALM findings on US and MRI. In this article, the current knowledge of the characteristic vascular status of subtype of subcutaneous ALM on color and power Doppler US along with MRI appearances will be reviewed.…”