ABSTRACT
We present a novel case of a malignant transformation of an extremity soft tissue angioleiomyoma to leiomyosarcoma in a man in his late 70s who presented with a painful and increasing lump on his anterior tibia. Initial imaging and biopsy showed a benign angioleiomyoma which was excised for symptomatic reasons. An analysis of the resulting specimen revealed a 50×42×15 mm smooth muscle neoplasm consistent with angioleiomyoma with a 22×11 mm entirely intralesional nodular component in keeping with a grade 1 leiomyosarcoma. The malignant constituent of the lesion was entirely encased in benign angioleiomyoma negating the need for further surgery. Systemic staging investigation revealed no evidence of metastatic disease spread final staging as per the eighth edition of the American Joint Committee on Cancer (AJCC) Staging T1N0M0 R0 Stage 1 a.
Subject(s)
Angiomyoma , Leiomyosarcoma , Tibia , Humans , Male , Leiomyosarcoma/pathology , Leiomyosarcoma/surgery , Leiomyosarcoma/diagnostic imaging , Tibia/pathology , Tibia/diagnostic imaging , Angiomyoma/pathology , Angiomyoma/surgery , Angiomyoma/diagnostic imaging , Aged , Cell Transformation, Neoplastic/pathology , Soft Tissue Neoplasms/pathology , Soft Tissue Neoplasms/surgery , Soft Tissue Neoplasms/diagnostic imaging , Biopsy , Bone Neoplasms/pathology , Bone Neoplasms/surgery , Bone Neoplasms/diagnostic imagingABSTRACT
BACKGROUND: Angioleiomyomas are benign mesenchymal tumors usually located in the limbs, with anecdotal reports in the spine. We present an atypical case of an epidural spine angioleiomyoma presenting with compressive myelopathy symptoms. The diagnosis was suggested based on MRI findings, and subsequently confirmed histopathologically. RESULTS: This is the first known occurrence of pure spinal epidural angioleiomyoma as a source of compressive myelopathy. The imaging presentation, especially the 'dark reticular sign' on MRI, was crucial in suggesting the diagnosis despite the atypical location CONCLUSION: This report serves to raise awareness among clinicians and radiologists about including angioleiomyoma in differential diagnoses for spinal epidural lesions with indicative MRI features. The favorable outcome after surgical intervention underscores the necessity of swift and accurate diagnosis followed by appropriate treatment for such uncommon spinal tumors.