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early draining veins were seen [Figure 2]. They may have foci of cartilaginous or adipose metaplasia.
Rarely, they might have calcification. Hemorrhage, necrosis,
[11]
Excision of the lesion was performed under brachial block. A single mitotic activity, vasculitis or fibromuscular dysplasia are not
2 cm in diameter spherical mass was identified [Figure 3]. The outer encountered.
surface was smooth and whitish in color. It was well encapsulated
[Figure 4]. Histopathology revealed a well-circumscribed tumor, Morphologically they have moderate or sparse cellularity.
composed of multiple thick-walled blood vessels with thickened They are composed of bundles of smooth muscles arranged in
smooth muscle coating. The smooth muscles were arranged in varying size fascicles admixed with varying amount of collagen
form of interlacing fascicles. Neither mitosis nor necrosis was
seen. Tumor cells were positive for smooth muscle actin and with intervening vascular structures. Occasional macrophages,
desmin, but they were negative for Bcl-2 and CD34. The features fat cells and ganglion-like cells are seen. Angiomyolipoma is a
were consistent with angioleiomyoma or vascular leiomyoma histological differential diagnosis. This lesion usually contains
[Figure 5]. adipose tissue in addition to smooth muscle and vascular
components. Angioleiomyoma cells stain positive for smooth
The patient was kept on regular follow-up. Six months following muscle markers like alpha smooth muscle actin, desmin, myosin,
surgery, there are no signs of recurrence. trichrome, HHF-35, calponin and h-caldesmon. These cells are
also positive for vimentin, type IV collagen and variably for S100.
DISCUSSION They stain negative for HMB-45 and estrogen receptor.

Angioleiomyomas are rare benign subcutaneous or deep dermal To conclude, angioleiomyoma of the hand is a rare differential
tumors of smooth muscle and vessels. They are also called diagnosis of a painful subcutaneous nodule in the extremities
angiomyomas or vascular leiomyomas. They are common among and has to be kept in mind during such clinical presentation.
females in 30-60 years of age.

Financial support and sponsorship
Angioleiomyomas present as slow growing painful solitary
nodules of extremities. Other rare sites have also been reported Nil.
[2-5]
in the literature including the labia majora, nipple, hard palate,
[6]
pinna, and sella. The most common presenting symptom is Conflicts of interest
[7]
pain, found in up to 60% of cases. This is attributed to stretching There are no conflicts of interest.
[8]
of nerves in tumor or capsule, or release of mediators from mast
cells. REFERENCES
Differential diagnoses to be considered in cases of painful 1. Ohtsuka H. Angioleiomyoma of the pulp. J Plast Surg Hand Surg 2014;48:285-
nodules in extremities are glomus tumor, traumatic neuroma, 6.
[1,9]
eccrine spiradenoma and angiolipoma. All are treated by 2. Mok JC, Fan KY, Lui TH. A huge angioleiomyoma of the finger. Hand Surg
surgical excision and they do not reoccur. The gross appearance 2015;20:310-2.
is firm and spherical nodule that is grayish white to brown in 3. Nishio J, Aoki M, Tanaka Y, Iwasaki H, Naito M. Painless angioleiomyoma of
color, and usually 2 cm or less in diameter. the first web space of the hand. In Vivo 2013;27:519-22.
4. Ogura K, Goto T, Nemoto T. Painless giant angioleiomyoma in the subfascia
of the lower leg. J Foot Ankle Surg 2012;51:99-102.
MRI features characteristic to angiomyomas include a 5. Raval A, Schulder M, Al-Atassi S. Neurosurgical management of a
hypodense peripheral capsule with linear or branching internal painful subcutaneous nodule of the knee: angioleiomyoma. Neurosurgery
hyperdensities on T2-weighted images, and postcontrast diffuse 2014;75:E190-4.
homogenous enhancement, with a vessel leading up to the 6. Eley KA, Alroyayamina S, Golding SJ, Tiam RN, Watt-Smith SR.
lesion in the majority of cases. These features were also seen in Angioleiomyoma of the hard palate: report of a case and review of the
our case. literature and magnetic resonance imaging findings of this rare entity. Oral
Surg Oral Med Oral Pathol Oral Radiol 2012;114: e45-9.
7. Xu Y, Jing Y, Ma S, Ma F, Wang Y, Ma W, Li Q. Primary angioleiomyoma in the
Histopathological examination showed well-circumscribed sellar region: a case report and literature review. Clin Neuropathol 2010;
fascicles of mature smooth muscle cells surrounding vascular 29:21-5.
lumina, lined by normal appearing endothelium without 8. Hachisuga T, Hashimoto H, Enjoji M. Angioleiomyoma. A clinicopathologic
[10]
elastic lamina. There are subtypes described in literature: (1) reappraisal of 562 cases. Cancer 1984 1;54:126-30.
solid type-closely compacted smooth muscle bundles; (2) venous 9. Lee HH, Park SH, Choi HY, Park HK. Eccrine spiradenoma arising in the
type-vessels have thick muscular walls that merge with smooth breast misdiagnosed as an epidermal inclusion cyst. Korean J Radiol 2011;
muscle bundles; and (3) cavernous type-dilated vascular channels 12:256-60.
with minimal smooth muscle that merges with smooth muscle 10. Shafi M, Hattori Y, Doi K. Angioleiomyoma of distal ulnar artery of the
hand. Hand (N Y) 2010;5:82-5.
bundles. The venous type is observed more in males, and in the 11. Onishi M, Takahashi K, Watabe D, Onodera H, Akasaka T. A case of
region of the head and neck. The solid type is more common in angioleiomyoma with epithelioid granuloma. Case Rep Dermatol 2011;
women, and in the lower extremities. 3:170-4.

128 Plast Aesthet Res || Volume 3 || April 25, 2016