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Presented by Theresa Chan, M.D. and prepared by Maryam Farinola M.D.
Case 4: 46-year-old male with a foot nodule.
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1. Question
Week 193: Case 4
46-year-old male with a foot nodule.images/vascular leiomyoma 1.jpg
images/vascular leiomyoma 2.jpg
images/vascular leiomyoma 3.jpg
images/vascular leiomyoma 4.jpgCorrect
Answer: Vascular leiomyoma
Histology: The tumor is well circumscribed. The cellular tumor consists of plump spindle cells arranged in short bundles or interlacing fascicles. In some areas, the spindle cells form long sweeping fascicles. Mitotic figures and necrosis are absent. The tumor shows an abundance of thick walled vessels.
Discussion: Vascular leiomyoma or angioleiomyoma is a benign lesion that usually occurs in the legs and feet of females. It is one of several tumors that present as painful nodules in the skin and soft tissue, others being angiolipoma, traumatic neuroma, glomus tumor, and eccrine spiradenoma. Histologically, the tumor is composed of smooth muscle bundles that appear to originate from medium-sized vessels. The vessels in the tumor are difficult to characterize, while thicker than veins, they lack elastic laminae. The tumor is cytologically bland, lacks mitotic activity and lacks necrosis, thus ruling out a leiomyosarcoma. The vascular pattern and plump smooth muscle cells are not consistent with neurofibroma.
Incorrect
Answer: Vascular leiomyoma
Histology: The tumor is well circumscribed. The cellular tumor consists of plump spindle cells arranged in short bundles or interlacing fascicles. In some areas, the spindle cells form long sweeping fascicles. Mitotic figures and necrosis are absent. The tumor shows an abundance of thick walled vessels.
Discussion: Vascular leiomyoma or angioleiomyoma is a benign lesion that usually occurs in the legs and feet of females. It is one of several tumors that present as painful nodules in the skin and soft tissue, others being angiolipoma, traumatic neuroma, glomus tumor, and eccrine spiradenoma. Histologically, the tumor is composed of smooth muscle bundles that appear to originate from medium-sized vessels. The vessels in the tumor are difficult to characterize, while thicker than veins, they lack elastic laminae. The tumor is cytologically bland, lacks mitotic activity and lacks necrosis, thus ruling out a leiomyosarcoma. The vascular pattern and plump smooth muscle cells are not consistent with neurofibroma.
