Angioleiomyoma of the right forefoot.

We describe a rare case of angioleiomyoma in the foot of a middle-aged man.

CASE AND IMAGE DESCRIPTION

A 64‐year‐old man with no history of trauma presented with a gradually increasing painless mass on the right forefoot. Physical examination revealed a solitary, painless, minimally mobile, and hard oval swelling measuring 13 × 13 mm. A sonogram identified a circumscribed, oval, homogeneously hypoechoic mass in contact with the dermis (Figure 1A), without internal blood flow signals. Magnetic resonance imaging (MRI) showed a well‐defined oval mass, isointense on T1‐weighted MR sequences and slightly hyperintense on T2‐weighted images (Figure 1B,C). Tumor excision was performed under local anesthetic nerve block. Histopathological results showed numerous blood vessels and smooth muscle bundles, indicating angioleiomyoma (Figure 2A,B). After one‐year follow‐up, he had normal physical activity with no tumor recurrence.

FIGURE 1

Sonogram of the third web space in the sagittal plane showing a well‐circumscribed, oval, homogeneously hypoechoic mass (13 × 13 × 7 mm) in contact with the dermis (A, arrow). The signal intensity of the oval‐shaped mass was isointense to the skeletal muscle on T1‐weighted magnetic resonance imaging (B, arrow), and slightly hyperintense to the skeletal muscle on the T2‐weighted imaging (C, arrowhead)

FIGURE 2

Histopathology slide showing closely packed fascicles of spindle cells with myoid features surrounding compressed vascular lumina (arrow) (A, hematoxylin and eosin, magnification ×4), and closely packed fascicles of spindle cells with myoid features surrounding compressed vascular lumina (arrow) (B, hematoxylin and eosin, magnification ×20)

Angioleiomyomas are one of the three forms of leiomyomas: piloleiomyomas, angioleiomyomas, and genital leiomyomas. They arise from the smooth muscle layer of blood vessels and are benign, rare, more likely to occur in the ovaries, uterus, bladder, lungs, or gastrointestinal tract and rarely involve the skin and subcutaneous soft tissue.

Clinical, sonographic, and MRI findings are insufficient to distinguish angioleiomyomas from other tumors, thus biopsies remain the gold standard. Therapeutic approaches depend on lesion size and symptoms severity, but simple excision and histopathology are recommended.

Question

What is the differential diagnosis in a patient with a gradually increasing painless mass on the forefoot?

Answer

Fibromas, lipomas, glomus tumors, ganglions, neurilemmomas, and leiomyosarcomas.

AUTHOR CONTRIBUTIONS

YJ, KI, and MT contributed to patient management. RI drafted the initial manuscript. All authors contributed to writing the manuscript. All the authors have provided written consent for publication.

CONFLICT OF INTEREST

None declared.

CONSENT

Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.