angiomyoma

Angiomyoma: A Rare Benign Tumor

Angiomyoma, also known as vascular leiomyoma or angioleiomyoma, is a rare benign tumor that arises from the smooth muscle layer of blood vessels. It is characterized by the presence of well-differentiated smooth muscle cells arranged around numerous thick-walled vessels [3][4].

Key Features

• Benign and non-cancerous: Angiomyomas are not cancerous and have a low recurrence rate after surgical excision [1-5].
• Smooth muscle origin: The tumor originates from the smooth muscle layer of blood vessels, specifically the tunica media of small to medium-sized arteries and veins [4][6].
• Vascular elements: Angiomyomas contain numerous thick-walled vessels surrounded by well-differentiated smooth muscle cells [7][9].
• Subcutaneous location: The tumor typically occurs in the subcutaneous tissues, with most common locations being the lower extremities [14].

Clinical Presentation

Angiomyomas are usually small (less than 2 cm), firm, movable, and slow-growing subcutaneous nodules. Pain is a common symptom, and they are most commonly seen on the extremities [12]. The patient may complain of a slowly enlarging painful mass.

Imaging Features

On ultrasound, angiomyomas appear as well-defined solid masses with smooth margins and no specific imaging features that distinguish them from other subcutaneous tumors [10].

Treatment and Prognosis

Management is primarily surgical excision, which is usually curative. Recurrence is rare after surgery [1-5].

Diagnostic Tests for Angiomyoma

Angiomyoma, also known as angioleiomyoma or vascular leiomyoma, is a benign pericytic or perivascular soft tissue tumor. Diagnosing angiomyoma can be challenging due to its nonspecific clinical features and imaging characteristics. However, various diagnostic tests can help confirm the diagnosis.

Imaging Tests

• CT scan: A CT scan may show a well-defined solid mass lesion with robust internal vascularity [10].
• MRI: MRI is a useful diagnostic tool that can reveal a characteristic dark reticular sign in most venous and cavernous types of angioleiomyoma [15]. MRI can also show a T1-isointense–to–slightly high signal, T2-high signal intensity, hypointense rim, and intense enhancement [11].
• Ultrasound: Ultrasound may show a well-defined solid mass lesion with robust internal vascularity [10].

Histopathological Examination

• Biopsy: A partial or excisional biopsy is necessary to establish the diagnosis of angioleiomyoma [7]. Histopathological examination can confirm the diagnosis by revealing a consistent pattern characterized by smooth muscle cells and blood vessels [3].
• Caldesmon assessment: Histopathological analysis may also involve assessing Caldesmon expression, which can be useful in confirming the diagnosis [4].

Other Diagnostic Tests

• Aspiration: Aspiration may be performed to rule out other differential diagnoses.
• EMG: Electromyography (EMG) may be used to assess muscle function and rule out other conditions.

It's essential to note that a definitive diagnosis of angioleiomyoma can only be made through histopathological examination. Imaging tests, such as CT scans, MRI, and ultrasound, can help narrow down the differential diagnoses but are not sufficient for confirmation [9].

References: [3] by M Bernard · 2024 [4] by M Bernard · 2024 [7] Jun 15, 2021 [9] by G Garg · 2014 · Cited by 41 [10] [11] [15]

Treatment Options for Angiomyoma

Angiomyoma, also known as angioleiomyoma or leiomyoma, can be treated with various methods, including drug treatment.

• Everolimus (Afinitor): This medication is used to treat angiomyoma by blocking the mammalian target of rapamycin (mTOR) pathway. It has been shown to be effective in reducing tumor size and preventing recurrence [4].
• GnRH-a: Gonadotropin-releasing hormone agonists (GnRH-a) have also been used to treat angiomyoma, particularly in cases where surgical resection is not feasible or desired. The treatment cycle can range from 3 months to 2 years, and most patients are started on GnRH-a immediately after the operation [12][13].

Other Treatment Options

While drug treatment is an option for angiomyoma, it's essential to note that surgery remains the primary treatment for this condition. Surgical resection is often considered the best course of action, especially in cases where the tumor is symptomatic or bleeding.

• Surgical Resection: Surgical removal of the tumor is usually recommended as the first line of treatment [7].
• Transarterial Embolization: This minimally invasive procedure involves blocking the blood supply to the tumor, making it an effective option for treating bleeding and symptomatic tumors [6].

Recurrence Rates

It's worth noting that while drug treatment can be effective in reducing tumor size and preventing recurrence, the risk of recurrence remains a concern. In some cases, adjuvant medical treatment may be necessary to prevent recurrence.

• Adjuvant Medical Treatment: Adjuvant medical treatment, such as GnRH-a, may be recommended to prevent recurrence after surgical resection [14].

Conclusion

In conclusion, drug treatment is an option for angiomyoma, particularly in cases where surgery is not feasible or desired. However, it's essential to note that surgery remains the primary treatment for this condition, and adjuvant medical treatment may be necessary to prevent recurrence.

References:

[4] - [9] [12] - [13] [14]

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