Synonyms

• Vascular leiomyoma
• angiomyoma

Category

Soft tissue

Behaviour

Benign

Gender

Female (2:1)

Tissue of Origin

Smooth muscle

Epidemiology

• Common Benign soft tissue tumour
• Peak incidence in 4th–6th decades
• Most common Benign soft tissue tumour of the Lower extremity

Clinical Features

• Small, painful subcutaneous nodule
• Pain exacerbated by cold, pressure, or menses
• Slow-growing, mobile nodule
• Rarely >2 cm in size

Location

• Lower extremity (leg, ankle, foot) most common
• Upper extremity
• Head and neck region
• Subcutaneous location virtually always

Imaging

• Small well-circumscribed solid nodule on ultrasound
• Hypoechoic with internal Vascularity on Doppler
• MRI: well-defined with homogeneous signal
• Rarely imaged - clinical diagnosis usually sufficient

Pathology

• Well-defined nodule with thick-walled vessels in smooth muscle stroma
• Three subtypes: solid (most common), cavernous, venous
• Smooth muscle cells with bland nuclei
• SMA, desmin positive; no significant atypia

Genetics

• No recurrent genetic abnormalities
• Benign neoplasm with simple karyotype

Treatment

• Simple local excision curative
• No need for wide margins

Prognosis

• Excellent - recurrence after complete excision is rare
• No Malignant potential

Key Points

• Pain is a cardinal feature - often out of proportion to size
• Female predominance and Lower extremity location are characteristic
• Must be distinguished from leiomyosarcoma (which is rare in subcutaneous tissue)
• Simple excision is curative

Workup - Blood Tests

• FBC - baseline
• No specific blood tests required for Benign lesion

Workup - Local Imaging

• Ultrasound - first-line; small hypoechoic subcutaneous nodule with internal Vascularity on Doppler
• MRI - if diagnosis uncertain or deep component suspected
• Plain radiograph - not routinely required

Workup - Biopsy

• Excision biopsy or core needle biopsy if clinical diagnosis uncertain
• Immunohistochemistry: SMA+, desmin+, confirms smooth muscle origin

Workup - Staging

No staging required

Follow-up Summary

• Post-operative review at 6 weeks
• No routine imaging required post-excision if histology confirms Benign angioleiomyoma
• Discharge with documented advice on returning if a new or recurrent symptomatic nodule appears
• No long-term Follow-up required - recurrence after complete excision is rare
• Patients with recurrent symptoms should be re-referred for clinical assessment and USS