Age / Sex : 60 / M

Chief complaint : Slow growing mass, right hand

What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy : Wan Tae Kim, Veterans Health Service Medical Center

Discussion

Answer:  Angioleiomyoma

Findings:

Axial and coronal T1-weighted MR images shows well demarcated soft tissue mass of isointense signal intensities compared with the skeletal muscles.

Axial and coronal T2-weighted MR images shows mixed areas of hyper- and isointense to adjacent muscles with a well-defined peripheral hypointense area suggesting fibrous capsule

Axial contrast-enhanced T1-weighted image shows heterogenous and strong enhancement of soft tissue mass.

Differential Diagnosis:

1. Neurogenic tumor


2. Hemangioma


3. Giant cell tumor


4. Synovial sarcoma

Diagnosis:  

Angioleiomyoma

Discussion:

Angioleiomyomas are a benign soft tissue tumor arising from smooth muscle cells of blood vessels. It is also known as an angiomyoma, vascular leiomyoma. The lesion originates in the tunica media of the blood vessels.

The peak incidence is in the fourth to sixth decades of life. There is a female predominance. Pain and tenderness is a common presenting symptom, possibly due to contraction of the smooth muscle fibers resulting in local ischemia.

MRI typically showed a well-defined oval or round masse in the subcutaneous fat layer in the extremities. The mass lesions were isointense to skeletal muscle on T1-weighted MR images and showed heterogenous high signal intensity relative to skeletal muscle on T2-weighted images. Gadolinium-enhanced T1-weighted images showed homogenous or heterogenous strong enhancement. A peripheral low signal intensity rim was seen on T1- and T2-weighted images corresponded to a fibrous capsule.

References:

1. Kumar S, Hasan R, Maddukuri SB, Mathew M. Angiomyoma presenting as a painful

subcutaneous mass: a diagnostic challenge. BMJ Case Rep. 2014 Oct 16;2014.

2. Yoo HJ, Choi JA, Chung JH, Oh JH, Lee GK, Choi JY, Hong SH, Kang HS.

Angioleiomyoma in soft tissue of extremities: MRI findings. AJR Am J Roentgenol.

2009 Jun;192(6):W291-4.

3. Kang BS, Shim HS, Kim JH, Kim YM, Bang M, Lim S, Park GM, Lee TY, Ha ND, Kwon


4. Angioleiomyoma of the Extremities: Findings on Ultrasonography and Magnetic

Resonance Imaging. J Ultrasound Med. 2019 May;38(5):1201-1208.