Weekly Case

Title : Case 636

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.



  1. 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.



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

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


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


To submit your answer, login first (for Korean radiologists) or send e-mail to balgundol@gmail.com (for non-Korean radiologists)

Correct Answer
Total applicants 39 Correct answers 7
Name Institution
김동언 국군양주병원, 전문의
이혜란 전문의
김지은 서울대학교병원, 전문의
최수연 전문의
조은경 새움병원, 전문의
김보라 전문의
장현식 전문의
Semi-Correct Answer
Total applicants 39 Semi-Correct answers 2
최형인 군의관, 전문의
김철영 이춘택병원, 전문의


  • 관리자 ( 2019-09-23 09:31:21 )
    "angioleiomyoma", "angiomyoma", "vascular leiomyoma" 모두 맞는 것으로 하였습니다.

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