Distal digital angioleiomyoma: a case report and review of the literature

Angioleiomyoma mimicking a swollen bursa on first metatarsophalangeal joint accompanying with hallux valgus deformity

We present a case of a patient who underwent a modified scarf osteotomy and tumour excision based on a preoperative diagnosis of hallux valgus deformity and accompanying bursitis. Subsequent histopathological examination revealed that the tumour was an angioleiomyoma. While tumours around the first metatarsophalangeal (MTP) joint are typically associated with gouty nodules, infections, or swollen bursa (bursitis) in patients with hallux valgus deformity, the occurrence of soft tissue tumours in this area is rare. Moreover, angioleiomyoma is an even rarer form of soft tissue tumour and is seldom suspected prior to resection. To our knowledge, there have been no reports of angioleiomyoma arising in the first MTP joint. However, it is important to consider the possibility of an atypical tumour in cases where soft tissue masses are present, even in patients with hallux valgus deformity, and to perform at least imaging tests such as ultrasound and magnetic resonance imaging before surgery. This prospect should always be kept in mind.

Angioleiomyoma-rare soft tissue tumor of the foot and ankle, review of two patients and review of the literature

Angioleiomyomas are relatively rare benign soft tissue tumors which often occur in the extremities. The true etiology is largely unknown and is seldom associated with pain. They are rarely diagnosed preoperatively as the clinical and radiological examinations are often nonspecific and inconclusive. The patients may face a considerable delay before a specialist treatment is sought due to the varied presentation/missed diagnosis preoperatively. This delay highlights the need for better characterizing the diagnosis and treatment of angioleiomyomas in clinical setting to expand awareness of this pathology, the differential diagnosis of lower extremity soft tissue tumors and the need for ongoing publication of such case reports. We wish to present two patients who came in with foot and ankle swellings and heel pain. Post-excision, these swellings were histologically diagnosed as benign angioleiomyomas.

Angioleiomyoma of the hand with nerve compression

Objective

This study was performed to analyze the clinical, radiographic, and pathological features of hand angioleiomyoma causing nerve compression and assess the outcomes of surgical excision.

Methods

This case series included three men and one woman (mean age, 53.3 years; range, 49–56 years). The patients’ chief complaint was numbness of the fingers. The patients’ medical histories were reviewed, and the diagnosis of angioleiomyoma with nerve compression was confirmed by means of imaging examination and pathological analysis.

Results

Three tumors occurred in the palm and one in the finger, and the average maximum tumor diameter was 1.8 cm (range, 0.8–2.6 cm). Preoperative magnetic resonance imaging demonstrated well-defined masses with isointense signals on T1 sequences, hyperintense signals on T2 sequences, and strong heterogeneous enhancement after injection of contrast material. All tumors were located near nerves, leading to nerve compression. The diagnosis of angioleiomyoma was confirmed by postoperative pathology. Finger sensation recovered and no recurrence was found during an average follow-up of 37 months (range, 25–59 months).

Conclusions

Angioleiomyoma should be considered among the differential diagnoses of hand tumors and timely resection should be performed, particularly if the mass is causing numbness and/or pain with positive Tinel’s sign and/or tenderness.

Primary Hand Leiomyoma: A Systematic Review

BACKGROUND

Primary leiomyoma is a rare cause of a mass in the hand, with few reported cases to date. To our knowledge, this constitutes the most comprehensive and up-to-date systematic review of the literature of all cases of primary hand leiomyoma. We also provide an additional case recently managed in our practice of confirmed primary vascular leiomyoma of the hand in a 44-year-old woman to add to the current body of literature.

METHODS

We performed a comprehensive literature review of all articles published on primary leiomyoma of the hand. The PubMed database was used, with search terms leiomyoma hand, angioleiomyoma hand, and angiomyoma hand. Articles were selected for their accuracy in anatomic localization in the hand and confirmed pathology of leiomyoma.

RESULTS

Our initial search query resulted in 216 articles. After applying the inclusion criteria, we identified 50 individual articles with 108 cases of confirmed primary leiomyoma in the hand from January 1, 1954, to July 1, 2018. Common initial clinical impressions recorded for primary hand leiomyoma included ganglion cyst, giant-cell tumor, hemangioma, and glomus tumor. Patients presenting with leiomyoma of the hand frequently describe a painful lesion, which differs from most other benign tumors of the hand at presentation.

CONCLUSIONS

Leiomyoma is an important consideration when developing a differential diagnosis for primary benign masses in the hand. We hope that this comprehensive review can provide increased awareness of this tumor type.

Angioleiomyoma of the Plantar-Medial Arch: A Case Report

An angioleiomyoma is a benign soft tissue tumour that arises from smooth muscle layer of blood vessels. The true aetiology of these masses is largely unknown and quite often may not be associated with pain. This paper illustrates the occurrence of an angioleiomyoma in the medial arch of the foot, a previously unreported location. Significant delay occurred in the patient being referred for specialist consultation, after attending numerous general practitioners for management. This highlighted the need for ongoing publication for case reports of this nature. The patient underwent excision with no recurrence of the lesion reported at 12 months. Often masses of this type may be left alone. However, when symptomatic simple excision will suffice where no other surrounding complication exists and where the mass is well encapsulated in the sub cutaneous area.

Angioleiomyoma of the pulp

Vascular leiomyomas or angioleiomyomas are benign solitary smooth muscular tumours that rarely occur in the distal finger. I report a 64-year-old man with uncommon clinical appearance in the pulp of the middle finger.

Giant laryngeal angioleiomyomas: a case report with review of literature

We report a recently encountered case of vascular leiomyoma in the larynx, a benign tumor that is rare in the organ, in a 52-year-old man. Chief complaints were a progressive hoarseness, laryngeal pain, deglutitive uncomfortableness and dyspnea in the supine position. Laryngoscope revealed many spherical tumors interlacing together with a smooth surface, measuring approximately 2x4 cm and covered with normal mucosa, found at the side of laryngeal epiglottis from its margin to supraglottis. Tracheotomy was performed under local anesthesia, and laryngosurgery was then carried out under general anesthesia. Histologic study showed smooth muscle cell proliferation, especially surrounded by an abundance of blood vessels, and the tumor was diagnosed as a vascular leiomyoma. Its complete resection was the best therapeutic option. Tracheotomy was required in this case depending on the occurrence site if the tumor and its size.

Epiphora as a presenting sign of angioleiomyoma of the lacrimal sac

A 50-year-old man presented with progressive enlargement of a right medial canthal mass for 5 years. The patient subsequently noted epiphora of 6-month duration on the affected side. An anterior orbitotomy was performed, which uncovered a well-circumscribed mass in the lacrimal sac. Histologic sections of the mass revealed an angioleiomyoma. Following complete excision, the epiphora resolved and there is no evidence of tumor recurrence at 1 year of follow-up. To the best of our knowledge, this is the first report of an angioleiomyoma in the lacrimal sac.