Angioleiomyoma with calcification of the heel: report of two cases.

Foot Ankle Int

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.

Published: September 2007

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http://dx.doi.org/10.3113/FAI.2007.1021DOI Listing

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Article Synopsis
  • Angioleiomyomas are benign tumors that develop from the smooth muscle of blood vessels and can occur in various body regions, though they are commonly found in the head, neck, and uterus.
  • A study examined 191 patients with trunk or extremity angioleiomyomas, finding that a high percentage experienced pain, with most tumors located in the lower extremities; imaging revealed non-specific soft tissue masses and specific characteristics on ultrasound and cross-sectional imaging.
  • Key imaging features to identify angioleiomyomas include a soft tissue mass near blood vessels, hypoechoic nature with internal vascularity on ultrasound, and certain MRI characteristics, which can help differentiate them from other conditions.
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Angioleiomyoma is a benign soft tissue tumor arising from vascular smooth muscle and most commonly presents in the lower extremities. We report a case of a 52-year-old right-hand dominant woman who presented with a 2-year history of intermittent, nonradiating left wrist pain, which she described as achy in nature without numbness or tingling. A focused physical examination revealed no edema, no obvious skin changes; there was tenderness over the volar-radial aspect of the left wrist, with an underlying firm, mobile, and palpable soft tissue mass.

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Angioleiomyomas are benign neoplasms, which usually present as solitary, slow-growing nodules on the skin of lower extremities, but acral location on the hands or feet is unusual. Yet, microscopically, they may show many histopathological variants, focal calcification is uncommon. Extensive calcification masquerading the real nature of the tumor has been rarely reported, the term acral calcified leiomyoma having been proposed for this entity.

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Based on histological findings, calcifying fibrous tumor (CFT) may be a late (burned out) stage of inflammatory myofibroblastic tumor (IMT). This concept, however, has not been proven by molecular means. Five CFTs were analyzed for IMT-related rearrangements in ALK, ROS1 and RET using fluorescence in situ hybridization (FISH).

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The patient was admitted of the chief complain "progressive snoring for two years, gradual enlargement of the neck neoplasm for six months". Specific examination indicated that bilateral cervical-mandibular margin to cervical root diffuse apophysis, most notably in the right thyroid plane.Posterior pharyngeal wall underwent an apophysis while no related vein engorgement was noticed.

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