Soft tissue
Pericytic (perivascular)

Topic Completed: 1 November 2012

Revised: 14 November 2019

Copyright: 2002-2019,, Inc.

PubMed Search: Angioleiomyoma [title]

Vijay Shankar, M.D.
Page views in 2018: 12,058
Page views in 2019 to date: 14,173
Cite this page: Shankar V. Angioleiomyoma. website. Accessed December 9th, 2019.
Definition / general
  • Benign, painful, subcutaneous or deep dermal tumor of smooth muscle and vessels
  • Part of morphologic spectrum with myopericytoma (Hum Pathol 2007;38:645) and myofibroma
  • Arises from smooth muscle of blood vessels without elastic fibers
  • Also called angiomyoma, vascular leiomyoma
  • Do NOT diagnose as "superficial angiomyolipoma" even if it contains some fat
  • Relatively common, usually females, ages 30 - 60 years
Clinical features
  • Solitary, slow growing nodule
  • Often in soft tissue of lower limbs, but tumors in males are more common in upper extremity, head and neck (Laryngoscope 2004;114:661)
  • Pain in 60% (Int J Clin Pract 2004;58:587), due to stretching of nerves in tumor or capsule or release of mediators from mast cells; pain may be exacerbated by wind, cold, pressure, menses
  • Other painful nodules are glomus tumor, traumatic neuroma, eccrine spiradenoma and angiolipoma
Case reports
  • Simple excision; does not recur
Gross description
  • Firm, sharply circumscribed gray-white-brown nodules
  • Usually 2 cm or less
Gross images

Images hosted on other servers:

Well demarcated tumors (left: small intestinal, right: posterior mediastinum)

Retromolar growth

Thigh nodule

Microscopic (histologic) description
  • Well circumscribed fascicles of mature smooth muscle cells surrounding vascular lumina, lined by normal appearing endothelium but with no elastic lamina present
  • Subtypes are solid (closely compacted smooth muscle bundles), venous (vessels have thick muscular walls that merge with smooth muscle bundles) and cavernous (dilated vascular channels with minimal smooth muscle that merges with smooth muscle bundles), but subtypes have no clinical significance (Cancer 1984;54:126)
  • Venous type is most common in head and neck, usually males
  • Solid type is most common in lower extremeties, usually females
  • May have foci of cartilaginous or adipose metaplasia
  • May have bizarre degenerative type cells similar to symplastic leiomyoma of uterus
  • Rarely prominent calcification in acral sites (J Am Acad Dermatol 2008;59:1000)
  • Rarely epithelioid cells (Am J Dermatopathol 1998;20:213) or epithelioid granulomas (Case Rep Dermatol 2011;3:170)
  • No hemorrhage, no necrosis, no mitotic activity, no vasculitis, no fibromuscular dysplasia
Microscopic (histologic) images

Images hosted on PathOut servers:

Contributed by Hillary Rose Elwood, M.D.

Low power view of well circumscribed dermal nodule

Higher power view of smooth muscle bundles with interspersed vascular lumens

 AFIP images

Smooth muscle and vessels, often thick walled

Smooth muscle merges with smooth muscle of lesion

Case of the Week #138

Nasal cavity (left to right): submucosal tumor composed of abundant thick-walled blood vessels blending with proliferative smooth muscle tissue; focal fatty metaplasia; smooth muscle actin+

Cytology description
  • Moderate or sparse cellularity
  • Usually uniform spindle cells mixed with smooth muscle cells and fragments of collagenous tissue in varying proportions
  • Occasional macrophages, fat cells, ganglion-like cells (Diagn Cytopathol 2002;27:161)
Positive stains
Negative stains
Differential diagnosis
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