Soft tissue
Pericytic (perivascular)
Angioleiomyoma
Author: Vijay Shankar, M.D.
Topic Completed: 1 November 2012
Minor changes: 20 January 2021
Copyright: 2002-2021, PathologyOutlines.com, Inc.
PubMed Search: Angioleiomyoma [title]
Table of Contents
Definition / general | Terminology | Epidemiology | Clinical features | Case reports | Treatment | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Positive stains | Negative stains | Differential diagnosisCite this page: Shankar V. Angioleiomyoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/softtissueangioleiomyoma.html. Accessed April 10th, 2021.
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
Terminology
- Also called angiomyoma, vascular leiomyoma
- Do NOT diagnose as "superficial angiomyolipoma" even if it contains some fat
Epidemiology
- 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
- 38 year old man with auricular angioleiomyoma (Turk Patoloji Derg 2011;27:268)
- 51 year old man with nasal turbinate mass (Case of the Week #138)
- 57 year old man with recurrent oral angioleiomyoma (Contemp Clin Dent 2011;2:102)
- 58 year old woman with angioleiomyoma of the small intestine (World J Surg Oncol 2007;5:129)
- 61 year old woman with a case of angioleiomyoma with epithelioid granuloma (Case Rep Dermatol 2011;3:170)
- 62 year old woman with angioleiomyoma of the nasal septum (Braz J Otorhinolaryngol 2010;76:675)
- 66 year old woman with symptomatic posterior mediastinal angioleiomyoma (Yonsei Med J 2008;49:666)
Treatment
- 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
Contributed by Jijgee Munkhdelger, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D.
Low power
Well defined nodule
Smooth muscle bundles, vessels
Organizing thrombus
Thin walled blood vessels
Thick walled blood vessels
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
- Alpha smooth muscle actin, desmin, myosin, trichrome, HHF35, calponin, h-caldesmon
- Also vimentin, type IV collagen, S100 in small nerve fibers
- Variable PR in nasal cavity cases (Acta Otolaryngol 2002;122:408, Chin Med J (Engl) 2007;120:350)
Differential diagnosis
- Angiomyolipoma: prominent adipose tissue component, HMB45+
- Leiomyoma with bizarre nuclei: no prominent vascular component
