Description, Causes and Risk Factors:
Angioleiomyoma is a benign tumor arising from the vascular smooth muscle (tunica media) and presents commonly between third and fifth decades of life. Although there are sporadic reports about this tumor in the literature, none describes all the information in detail.
Auricle, nose, lip, and neck are the most common sites of occurrence.
The exact etiology of angioleiomyomas is unknown. Minor trauma, hamartoma changes, venous stasis, and hormonal imbalance have been proposed as etiological features. An arteriovenous malformation has also been cited in the literature.
Oral angioleiomyomas occur in the age range of 3.5-85 years with a mean of 50-55 years. The gender predilection has been controversial Angioleiomyomas are common among Caucasians (66%) and in African-Americans (16.1%). Within the oral cavity, angioleiomyomas are virtually found everywhere, with the common locations being lower lip and palate and also centrally within the mandible.
This review is an attempt to collate all the facts in one concise article. Angioleiomyoma presents as a painful mass in approximately 60% of the cases. One of the distinct clinical features noted is the increase in size of the swelling with physical activity of the involved part, especially in the hand. It should be considered in the differential diagnosis of painful nodular lesions of the extremity. Pre-operative diagnosis is difficult, but with a high index of suspicion and awareness, it is possible. The use of ultrasound and magnetic resonance imaging should be considered. It causes minimal morbidity and excision is usually curative. Histological examination using smooth muscle Actin stain portraits the smooth muscle bundles clearly.
Clinically they appear as sessile growths ranging from 2 mm to 2 cm in size.They are firm in consistency and color varies from red to pink to gray.Although the lesions have a vascular origin, only about half of them exhibit red, purple, or blue color.They grow slowly and are mostly symptom free.When present, pain is the common symptom.The cause of pain in angioleiomyomas has been predicted to be either due to local ischemia or neural irritation in the tumor.The surface of the lesions is usually smooth and rarely can get ulcerated as a result of trauma from occlusive forces.
The differential diagnoses include true or false aneurysm, hemangioma, lipoma, ganglion, pigmented villonodular synovitis, giant cell tumor of a tendon sheath, and neurofibroma.Making an initial diagnosis of angioleiomyoma is difficult at a location apart from the predilection sites because of its nature of having no clinical symptoms or diagnostic characteristics.
Conventional radiographs aremostly inconclusive. Rarely, theymay show scalloping of the cortex ofthe adjacent bone, reflecting thepresence of a slow-growing benignmass. Intralesional dystrophiccalcifications have been describedas well, but are only exceptionallyseen.On ultrasound, the tumor ishomogeneously hypoechoic, withwell-defined margins and withoutcontact with the superficial fascia.Typically, the tumor is oval-shapedwith the longest axis parallel to theextremity axis. Color Doppler USreveals hypervascularity.According to Gomez-Dermit et al.,the Doppler spectrum was most commonly of low resistance, but highresistance pattern may be seen aswell, rendering this feature less helpful in the characterization process.The different Histopathological subtypes all display similar MRappearance.
The treatment of choice for angioleiomyomas is simple excision of the mass, followed by ligation of the tumor-feeding vessels. In some cases, angioleiomyomas may originate in the muscle wall of an artery and, if collateral circulation is insufficient, simple excision may not be satisfactory and repair of this artery may be necessary.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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