Angioleiomyomas of the Extremities and Trunk: An Observational Study

Rationale and objectives: Angioleiomyomas are benign perivascular tumors that originate from the tunica media of blood vessels. While frequently described in the head, neck, and uterus, angioleiomyomas can manifest in various regions throughout the body. The purpose of this study was to review the history and imaging features of angioleiomyomas of the trunk and extremities.

Materials and methods: Patients with pathologically proven angioleiomyomas at our institution were retrospectively identified. Clinical information was obtained by chart review. Any available imaging of the tumor was reviewed.

Results: This study includes 191 patients with angioleiomyoma of the trunk or extremities, 87 with imaging of the tumor. Mean age at presentation was 55.5 years and 59.7% of patients were female. The tumor was painful in 88.9% of patients. Most lesions were in the lower extremity (79.1%), followed by the upper extremity (17.8%) and trunk (3.1%). A nonspecific soft tissue mass was visible radiographically in 27.4% of cases, with calcifications in 1.8%. On ultrasound, the tumor was always hypoechoic, with internal vascularity in 93.8%. Most tumors were T1 isointense and T2 hyperintense relative to skeletal muscle (92.9%) and enhanced (95.8%). CT showed a soft tissue density mass in all cases. On cross-sectional imaging, the mass was directly adjacent to a blood vessel in 83.1% of cases.

Discussion: Key imaging features of angioleiomyomas include a soft tissue mass with adjacent blood vessel on cross-sectional imaging. Ultrasound shows a hypoechoic mass with internal vascularity. They are typically T1 isointense, T2 hyperintense enhancing masses which may have a dark reticular sign and/or hypointense peripheral rim. Recognizing these features may help include angioleiomyoma in the differential diagnosis.