Angioleiomyoma in the ankle mimicking tarsal tunnel syndrome: 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.

A case of Epstein-Barr virus-associated smooth muscle tumor of the posterior interosseous nerve mimicking schwannoma

Here we report a case of Epstein-Barr virus (EBV)-associated smooth muscle tumor (SMT) of the peripheral nerve in a young man seropositive for human immunodeficiency virus (HIV). Initially, the lesion was clinically and radiologically confused with a schwannoma of the forearm's posterior interosseous nerve. The diagnosis was corrected by histological examination, which revealed a well-defined tumor consisting of eosinophilic spindle cells, positive for α-smooth muscle actin on immunohistochemistry and positive for EBV-encoded early RNA (EBER) on in situ hybridization. EBV-associated SMTs are well described in the literature; they are frequently multiple and arise in many organs. They occur preferentially in young adults with poorly controlled and chronic HIV infection. The prognosis is influenced by the complications of immunodeficiency. To our knowledge, this is the first description of a peripheral nerve location. Because EBV-associated SMT should be considered in the differential diagnosis of a tumor in the peripheral or central nervous systems in immunocompromised patients, EBV should be tested in these locations. Thus, a cause of immunodeficiency should be identified when the diagnosis of EBV-associated SMT is made.

Intra-articular leiomyoma of the knee mimicking a ganglion cyst in a child: A case report and review of literature

INTRODUCTION AND IMPORTANCE

Angioleiomyoma is a rare benign soft tissue tumor of smooth muscle getting its origin from the muscular layer of vessel walls. The localized type of leiomyoma occurs on the skin, deep soft tissues, in the genitourinary, gastrointestinal, and respiratory tracts.

CASE PRESENTATION

We report a case of a 16-year-old patient who presented with an intra-articular leiomyoma developed in the anterior cruciate ligament and treated with arthroscopy.

CLINICAL DISCUSSION

Angioleiomyoma can occur anywhere in the body and is most often seen in the extremities, particularly the lower limbs, but is very rare in the knee joint. Angioleiomyoma should be included in the differential diagnosis of nodular lesions mimicking loose body, such as lipomas, inclusion cysts, ganglion, pigmented villonodular synovitis (PVNS), fibroma, nodular synovitis, hemangioma, synovial sarcoma, myopericytoma, leiomyosarcomas, glomus tumor.

CONCLUSION

Angioleiomyoma related to the cruciate ligaments of the knee should be considered in the differential diagnosis of a painful knee especially when associated with a decreased of range of motion of knee. The arthroscopic debridement should be considered the treatment of choice in order to reliably restore active ROM.

Radial neuropathy caused by intraneural leiomyoma: A case report

INTRODUCTION

Leiomyoma of peripheral nerve is a rare condition characterized by neuropathy of affected nerve. We herein report a rare presentation of leiomyoma of radial nerve which presented with wrist drop.

PATIENT CONCERNS

A 37-year-old man visited our clinic with a history of sudden onset weakness of the wrist dorsiflexion/finger extension of the right side.

DIAGNOSIS

T2-weighted with fat saturation image of MRI demonstrated a well-defined, intra-neural, round mass of about 0.8 cm × 0.5 cm within the radial nerve. Excision of mass established the pathological diagnosis of intra-neural leiomyoma.

INTERVENTIONS

The patient underwent excision of mass and attached nerve tissue, followed his medial antebrachial nerve graft for repair of the defected radial nerve.

OUTCOMES

As of the 1-year follow-up, no symptoms of recurrence have been observed. Also, the strength of wrist dorsiflexion improved to grade 4/5 CONCLUSION:: This rare case demonstrates the importance of MR imaging to differentiate intra-neural leiomyomas from other benign peripheral nerve sheath tumors. Surgical treatment plays an important role in the treatment of patient with intraneural leiomyoma with neurologic deficits.

Angioleiomyoma (Vascular Leiomyoma) Presenting as a Pseudoaneurysm of the Tibialis Posterior Artery

Reported here is the case of a 55-year-old woman presenting to a podiatry clinic with a chief complaint of left heel and ankle pain, who ultimately underwent operative excision of an angioleiomyoma adjacent to the tibialis posterior artery at the level of the medial malleolus. Accompanying this case are images from three modalities through which the defining characteristics of an angioleiomyoma can be appreciated. This case advocates for the inclusion of angioleiomyoma in the preoperative differential diagnosis of a mass presenting as a pseudoaneurysm in the lower extremity, particularly among women in the fourth to sixth decades of life.

A Case of Vascular Leiomyoma Causing Osseous Malformations in the Foot

A vascular leiomyoma is a vascular soft tissue tumor that is relatively rare and benign. They usually occur as solitary lesions and are well encapsulated. The present study describes a unique case of vascular leiomyoma causing erosions of a metatarsal secondary to compression from the tumor. We present a female in her fourth decade of life with osseous malformations of the third metatarsal that became painful after an acute trauma to the foot.

The diagnosis and arthroscopic treatment of angioleiomyoma presenting loose body in the knee joint: two case reports

Background

Angioleiomyoma is a very rare benign solitary soft tissue neoplasm originating from smooth muscle layer of blood vessels. The tumor is usually located in the subcutis or the superficial fasciae, but less often in the deep fasciae, especially rare in the knee joint cavity. Diagnosis is frequently delayed or misdiagnosed as loose body or anterior knee pain because of its rare occurrence and poor awareness of physicians. Few studies have presented intra-articular angioleiomyoma and such cases become rarer and more difficult to diagnose when it presents as loose body.

Case presentation

Two patients, a middle-aged man and an old woman, presented to our outpatient clinic with persistent anterior knee pain and both of them suffered from a solitary mass in the right knee that had slowly enlarged. One of two patients showed negative in the routine radiographic imaging and the other showed a “loose body” beside the lateral femoral condyle in the knee. MRI showed both a well-demarcated intra-articular mass of isointense signal to muscle on T1-weighted images and heterogeneous intensity on T2-weighted images. Their tumors were excised under arthroscopy finally, with the pathological results revealed vascular leiomyomas. They both recovered well with pain free after operation and no signs of recurrence were seen at the 7-year follow-up.

Conclusions

This case report illustrates the atypical locations of angioleiomyoma in the knee joint should arouse our attention and be included in the differential diagnosis of nodular lesions mimicking loose bodies.

Leiomyoma of the Foot and Ankle: A Case Series

Leiomyoma is a benign soft-tissue tumor that can arise in any soft tissue; however, in the extremities, it is usually a subcutaneous mass. Masses in the foot and ankle in general are rare, and few reports in the literature describe leiomyoma in this region of the body. We present a series of 8 cases of leiomyoma of the foot and ankle, 4 of which are subclassified as angioleiomyomas. The characteristic patient presentation, imaging, and histological findings are presented here to increase awareness of this soft-tissue mass in the foot and ankle.

LEVELS OF EVIDENCE

Level V.

Angioleiomyoma in the posterior knee: A case report and literature review

The authors present a case of angioleiomyoma situated in the posterior knee. A 47-year-old Caucasian woman presented in 2011 with recurrent stabbing pain on the lateral aspect of her right knee. She reported having pain for the last 6years. She had no history of trauma. In 2008 she was treated with a diagnostic arthroscopy and transposition of the tibial tuberosity, with no benefit to her symptoms. Electromyography of the lower limbs showed asymmetry of the amplitude of sensitive action potential of the superficial fibular nerve. Based on the clinical suspicion of entrapment of the common fibular nerve at its bifurcation, a surgical exploration was performed, but pain persisted. In 2014, ultrasonography localized at the trigger point showed a solid ovular formation of 1cm in diameter situated on the posterior aspect of the external femoral condyle in proximity to the joint capsule, which was confirmed by magnetic resonance imaging (MRI). Surgical excision of the 1-cm diameter tumor mass relieved the symptoms immediately and permanently. Histology evidenced the presence of a solid-type angioleiomyoma. The presence of an angioleiomyoma at the knee joint is very rare and few cases are reported in the literature. To the authors' knowledge this is the first time an angioleiomyoma in the posterior knee has been described. In case of unexplained and persistent pain in and around the knee, clinicians should be aware of the atypical locations of this tumor, considering that its surgical excision alone may relieve symptoms permanently.

Plantar heel pain due to vascular leiomyoma (angioleiomyoma)

The differential diagnosis of heel pain is extensive. The plantar heel pain is usually due to mechanical etiology, including plantar fasciitis, calcaneal spur, stress fracture, and nerve entrapment. Tumor is a rare cause of plantar heel pain. We present a case of chronic plantar heel pain with a vascular leiomyoma at the heel pad.