RESUMO
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.
Assuntos
Angiomioma , Leiomiossarcoma , Tíbia , Humanos , Masculino , Leiomiossarcoma/patologia , Leiomiossarcoma/cirurgia , Leiomiossarcoma/diagnóstico por imagem , Tíbia/patologia , Tíbia/diagnóstico por imagem , Angiomioma/patologia , Angiomioma/cirurgia , Angiomioma/diagnóstico por imagem , Idoso , Transformação Celular Neoplásica/patologia , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Biópsia , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Neoplasias Ósseas/diagnóstico por imagemRESUMO
Angioleiomyoma is a benign tumor, which arises from the smooth muscle. It comprises approximately 4.4% of all benign soft tissues' neoplasms and they are commonly located at the lower extremities. They are most frequently found in middle-aged women. Angioleiomyoma is usually presented as a painful solitary lesion in the subcutaneous tissue. Due to the lack of evidence in the literature, the aim of this current concepts review was to provide foot and ankle surgeons the most updated and useful information for diagnosis and management of foot or ankle's angioleiomyoma. The possible diagnosis of angioleiomyoma is rarely thought of before surgery. X-ray, US, MRI, aspiration, scintigraphy, CT and EMG make part of the diagnostic tools available and angioleiomyoma's main characteristics in each of the exams are detailed. Angioleiomyoma cannot be neglected as consequence of delay or mistreatment increases morbidity and the potential risk to malignant transformation.
Assuntos
Angiomioma , Neoplasias de Tecidos Moles , Pessoa de Meia-Idade , Humanos , Feminino , Tornozelo/diagnóstico por imagem , Angiomioma/diagnóstico por imagem , Angiomioma/cirurgia , Extremidade Inferior/patologia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/cirurgia , Articulação do Tornozelo/patologiaRESUMO
INTRODUCTION: Primary intracranial angioleiomyoma (ALM) is quite rare and ALM of the adolescent is even rarer. To date, only three cases of adolescents have been reported. MATERIAL AND METHODS: We carefully introduced a new location of intracranial ALM in an adolescent. The clinical, pathological and imaging features of intracranial ALM were described in detail and published literature was reviewed. RESULTS: To our best knowledge, we presented the fourth primary intracranial ALM of adolescent and the first ALM of the right frontal cranial base with intracranial and extracranial communication. We not only summarize the generalities of ALM but also illustrate the difference between adult and adolescent ALM in the aspects of gender and age predominance, etiology, common location and pathologic subtype. CONCLUSIONS: We reported the first ALM of the right frontal cranial base with intracranial and extracranial communication of an adolescent with a good prognosis. We also summarize the generalities of ALM and illustrate the difference between adult and adolescent ALM. Future investigation of control study with large patient cohorts is needed for both adult and adolescent ALM to compare the difference between them.
Assuntos
Angiomioma , Adulto , Adolescente , Humanos , Angiomioma/diagnóstico por imagem , Angiomioma/cirurgia , Base do CrânioRESUMO
Angioleiomyomas are smooth muscle masses originating from blood vessel tunica media. This is a rare tumor, comprising less than 1% of benign sinonasal cavity tumors. Failure to recognize and surgically excise nasal angioleiomyomas can result in lesion recurrence. We present 2 new cases of nasal septum angioleiomyoma at a single institution. Additionally, both cases underwent septal and nasal surgery. Due to the nonspecific clinical and imaging findings, a high index of suspicion is needed to diagnose nasal septum angioleiomyoma, often requiring histopathological verification. Preferred treatment is complete surgical excision. From our experience, concurrent corrective septal and sinus surgery can be completed with tumors less than 1.0 cm in size.
Assuntos
Angiomioma , Procedimentos Cirúrgicos Nasais , Humanos , Angiomioma/diagnóstico por imagem , Angiomioma/cirurgia , Septo Nasal/cirurgia , Septo Nasal/patologiaRESUMO
Angioleiomyoma in the head and neck area is rarely observed. This report introduces 2 cases of angioleiomyoma discovered in the parotid gland, particularly with the superficial temporal artery (STA) as the feeding vessel. Each patient was evaluated preoperatively by clinical manifestation and computed tomography scan, but the difficulty was encountered due to nonspecific radiologic features of angioleiomyoa. Surgical intervention was performed for precise diagnosis and treatment. The tumors were fed from the STA, with the diagnosis of venous type parotid angioleiomyoma. To our knowledge, there have been only one previous report of angioleiomyoma of the parotid gland fed from STA in the literature. Once parotid tumor is discovered, although rare, the possibility of angioleiomyoma should be considered, and the authors recommend prompt surgical excision for accurate diagnosis and treatment.
Assuntos
Angiomioma , Neoplasias Parotídeas , Humanos , Glândula Parótida/cirurgia , Artérias Temporais , Angiomioma/diagnóstico por imagem , Angiomioma/cirurgia , Neoplasias Parotídeas/diagnóstico por imagem , Neoplasias Parotídeas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To identify the characteristic magnetic resonance imaging (MRI) findings in angioleiomyoma and to clarify its relationship with histopathological findings. MATERIALS AND METHODS: We retrospectively analyzed the MRI findings and pathological subtypes in 25 patients with subcutaneous angioleiomyoma of the extremities. Based on the previous reports, MRI findings that could be characteristic of angioleiomyoma were extracted. According to the World Health Organization classification, all cases were classified into three pathological subtypes: solid, venous, and cavernous. The relationship between MRI findings and pathological subtypes was analyzed. RESULTS: The pathological subtypes were solid (n = 10), venous (n = 11), and cavernous (n = 4). The following MRI findings were observed: (a) hypo- or iso-intense linear and/or branching structures on a T2-weighted image (positive total/solid/venous/cavernous: 19/5/10/4, respectively), which we defined as "dark reticular sign"; (b) peripheral hypointense rim on a T2-weighted image (positive total/solid/venous/cavernous: 19/7/8/4, respectively); and (c) presence of any adjacent vascular structures (positive total/solid/venous/cavernous: 6/3/3/0, respectively). Chi-square test showed a significant relationship between dark reticular sign and pathological subtypes (p = 0.0426). The dark reticular sign was found more frequently in the venous and cavernous types than in the solid type. The other MRI findings did not reveal a significant relationship between pathological subtypes. CONCLUSION: We present the largest case series exploring MRI findings in angioleiomyoma. The dark reticular sign was a characteristic MRI finding of angioleiomyoma and was seen in most of the venous and cavernous types, which may facilitate preoperative diagnosis.
Assuntos
Angiomioma , Angiomioma/diagnóstico por imagem , Angiomioma/patologia , Extremidades/diagnóstico por imagem , Extremidades/patologia , Humanos , Imageamento por Ressonância Magnética/métodos , Estudos Retrospectivos , Tela SubcutâneaRESUMO
Angioleiomyomas are benign tumors composed of smooth muscle and vascular endothelium. While infrequent in overall prevalence, they are exceptionally rare in the head and neck. Herein, we describe the case of a 65-year-old female who was found to have an angioleiomyoma of the right nasolacrimal duct. Endoscopic excision of the lesion along with medial maxillectomy and dacryocystorhinostomy was performed without complication. The current report is one of the few reported cases of angioleiomyoma of the lacrimal drainage system.
Assuntos
Angiomioma , Dacriocistorinostomia , Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Feminino , Humanos , Idoso , Ducto Nasolacrimal/diagnóstico por imagem , Ducto Nasolacrimal/cirurgia , Ducto Nasolacrimal/patologia , Angiomioma/diagnóstico por imagem , Angiomioma/cirurgia , Angiomioma/complicações , Dacriocistorinostomia/efeitos adversos , Endoscopia , Obstrução dos Ductos Lacrimais/etiologiaRESUMO
A 65-year old woman presented with 3-year history of painless, gradual swelling of the right upper eyelid associated with proptosis. Computed tomography (CT) and magnetic resonance imaging (MRI) of the orbit showed a well circumscribed soft tissue mass in the supero-lateral orbit. An excision biopsy of the lesion was performed via lateral orbitotomy. Histopathology examination and immunochemistry staining confirmed the diagnosis of cavernous angioleiomyoma. The tumour was excised completely. Orbital angioleiomyoma is a rare benign tumour and the lesion can cause visual morbidity, particularly when intraconal. Despite sophisticated imaging modalities, histopathological analysis is essential for diagnosis. Angioleiomyoma should be included in the differential diagnosis of well-defined orbital lesions. Complete surgical excision carries a low risk of recurrence.
Assuntos
Angiomioma , Exoftalmia , Neoplasias Orbitárias , Idoso , Angiomioma/diagnóstico por imagem , Angiomioma/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Órbita , Neoplasias Orbitárias/diagnóstico por imagem , Neoplasias Orbitárias/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Angioleiomyomas typically present as small, painful, soft-tissue tumors less than 2 cm in diameter. The features of angioleiomyomas on magnetic resonance (MR) imaging are not well understood, and the association of MR findings with histologic subtype is unclear. In the present study, the MR features of angioleiomyomas of average size were compared in relation to histologic subtype. METHODS: This retrospective review of medical records analyzed MR imaging data and histologic specimens from 18 consecutive patients with angioleiomyomas that were resected at our hospital during the period from January 2006 through December 2013. RESULTS: On T1-weighted images, lesions exhibited homogeneous areas that were isointense with skeletal muscle. However, T2-weighted images of solid and venous angioleiomyomas showed heterogeneous areas that were isointense or slightly hyperintense, while cavernous angioleiomyomas exhibited hyperintensity. Most lesions had a hypointense rim, and two thirds had adjacent vessels. CONCLUSIONS: Our results suggest that MR findings for angioleiomyoma vary in relation to histologic subtype. T2-weighted images of solid and venous angioleiomyomas yielded specific MR findings that allowed for differentiation from other soft-tissue tumors, such as soft-tissue sarcomas. Most of these tumors exhibited isointense to slightly hyperintense regions, as compared with skeletal muscle, while findings for cavernous angioleiomyomas were nonspecific. Thus, clinical findings and MR imaging were almost sufficient for preoperative diagnosis of solid and venous angioleiomyomas.
Assuntos
Angiomioma/diagnóstico por imagem , Angiomioma/patologia , Imagem de Difusão por Ressonância Magnética , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/patologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosAssuntos
Angiomioma/complicações , Veia Femoral/patologia , Hamartoma/complicações , Leiomiossarcoma/complicações , Doenças Linfáticas/complicações , Linfedema/etiologia , Neoplasias Vasculares/complicações , Idoso de 80 Anos ou mais , Angiomioma/diagnóstico por imagem , Angiomioma/patologia , Veia Femoral/diagnóstico por imagem , Veia Femoral/cirurgia , Hamartoma/diagnóstico por imagem , Hamartoma/patologia , Humanos , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/patologia , Leiomiossarcoma/cirurgia , Linfonodos/patologia , Doenças Linfáticas/diagnóstico por imagem , Doenças Linfáticas/patologia , Masculino , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Tomografia por Emissão de Pósitrons , Pseudolinfoma/complicações , Pseudolinfoma/diagnóstico por imagem , Pseudolinfoma/patologia , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/patologia , Neoplasias Vasculares/cirurgiaRESUMO
BACKGROUND: Angioleiomyoma of the pulmonary artery is rare in the literature and few studies have been reported. Here we present a rare case of angioleiomyoma arising from the pulmonary artery in a young patient. CASE PRESENTATION: A 27-year-old male patient presented to our clinic due to the incidental finding of a nodule in the right lower lobe of the lung, which was unchanged from the prior year. Preoperative CT scans showed a well-demarcated nodule of soft tissue density penetrated by the basal branch of the right anterior basilar artery (RA8b). Single-port video-assisted RS8 segmentectomy was performed under the guidance of preoperative 3-dimensional reconstruction for histologic confirmation of the tumour. The tumour appeared as a solid tumour of a tube-like structure with vascular endothelium, composed of spindle-shaped smooth muscle cells lacking nuclear atypia and homogenous red-dye substances. The spindle cells were positive for immunostaining for smooth muscle actin (SMA), desmin and Ki-67 and were negative for immunostaining for Dog-1, HMB45, and Melan-A. A pathological diagnosis of primary angioleiomyoma of the pulmonary artery was finally made. CONCLUSIONS: This report is a reminder for thoracic surgeons that angioleiomyoma should be included in the differential diagnosis of lung neoplasms, especially for the mass of soft tissue density penetrated by pulmonary blood vessels shown by CT. Awareness of this rare entity should potentially prevent underdiagnosis and improper surgical treatment.
Assuntos
Angiomioma/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Neoplasias Vasculares/diagnóstico por imagem , Adulto , Angiomioma/patologia , Angiomioma/cirurgia , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Artéria Pulmonar/patologia , Artéria Pulmonar/cirurgia , Tomografia Computadorizada por Raios X , Neoplasias Vasculares/patologia , Neoplasias Vasculares/cirurgiaRESUMO
Angioleiomyoma is a benign soft tissue tumor which usually occurs in superficial or deep soft tissues. Only rarely does this tumor occur at unusual sites, including retroperitoneum. We present a rare case of lumbo-sacral angioleiomyoma in a 54-year-old man. Apart from this unusual site, the most striking morphological feature was the presence of numerous keloid-like collagen fibers interspersed among the fascicles of the neoplastic cells. Radiological, morphological and immunohistochemical features are presented, and differential diagnosis with its potential morphological mimickers is discussed.
Assuntos
Angiomioma/diagnóstico por imagem , Colágeno , Queloide/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Angioleiomyoma is a benign soft tissue tumor that manifests as pain and is more common in the extremities. However, primary intracranial angioleiomyoma is an extremely rare entity that is poorly characterized clinically, radiologically, and histopathologically. We compiled and examined reported cases of intracranial angioleiomyoma to provide an up-to-date summary of the condition. A literature search was performed using PubMed with specific key terms. Selected case studies and case series were then compared, and statistical analyses were performed where appropriate. CASE DESCRIPTION: A 59-year-old woman presented with epileptic seizures and a 2-month history of progressive headache. Magnetic resonance imaging of the brain revealed a right temporal pole tumor near the right cavernous sinus. Gross total resection was performed. Histopathologic and immunohistochemical examination demonstrated an angioleiomyoma. No adjuvant radiation or chemotherapy was administered. Magnetic resonance imaging of the brain performed at 6-month follow-up showed no signs of recurrence. CONCLUSIONS: Primary intracranial angioleiomyoma is an exceedingly rare central nervous system tumor. The clinical and radiologic manifestations are nonspecific. The diagnosis depends on the histopathologic and immunohistochemical examination. For patients with clinical symptoms, surgical resection should be the first-choice treatment.
Assuntos
Angiomioma/cirurgia , Neoplasias Encefálicas/cirurgia , Angiomioma/complicações , Angiomioma/diagnóstico por imagem , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Seio Cavernoso/diagnóstico por imagem , Feminino , Cefaleia/etiologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Procedimentos Neurocirúrgicos/métodos , Convulsões/etiologia , Resultado do TratamentoRESUMO
Benign smooth muscle tumors of the inferior vena cava (IVC) are unusual, but mostly consist of intravenous leiomyomatosis, which arises from the uterus. Primary leiomyoma of the IVC is extremely rare. Here, we report a primary leiomyoma of the IVC, misleadingly reported as a cystic neoplasm of the pancreas in images. Immunohistochemical analysis was positive for (estrogen receptor) ER and (progesterone receptor) PR, indicating gynecologic leiomyomas. The use of ER and PR immunostaining is recommended to help distinguish between somatic and gynecologic leiomyomas, whose criteria of malignancy differ.