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Presented by Pedram Argani, M.D. and prepared by Lynette S. Nichols, M.D.
Case 3: The patient is a 66-year old female with a painful hand mass and a history of invasive lobular carcinoma of the breast.
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1. Question
Week 133: Case 3
The patient is a 66-year old female with a painful hand mass and a history of invasive lobular carcinoma of the breast./images/Lyn’s/2p-3a.jpg
/images/Lyn’s/2p-3b.jpg
/images/Lyn’s/2p-3c.jpgCorrect
Answer: Angiomyoma
Histology: The lesion contains vessels that have thick walls composed of smooth muscle. The smooth muscle has the classic spindle cell shape with eosinophilic cytoplasm and perinuclear vacuoles.
Discussion: Glomus tumors are typically subungal, and the lesional cells are round rather than elongated. Arteriovenous malformations are characterized by irregularly thickened walls, and typically demonstrate disruption of the blood vessel’s elastic layers. Pilar leiomyomas arise from the arrector pili muscles of the skin, and are frequently multiple.
Vascular leiomyomas (angioleiomyoma, angiomyomas) are one of the classic five painful cutaneous nodules of the skin, remembered by the mnemonic “ANGEL”. These lesions are: Angiolipoma, Neuroma (traumatic), Glomus tumor, Eccrine Spiradenoma, Leiomyoma (vascular).
Incorrect
Answer: Angiomyoma
Histology: The lesion contains vessels that have thick walls composed of smooth muscle. The smooth muscle has the classic spindle cell shape with eosinophilic cytoplasm and perinuclear vacuoles.
Discussion: Glomus tumors are typically subungal, and the lesional cells are round rather than elongated. Arteriovenous malformations are characterized by irregularly thickened walls, and typically demonstrate disruption of the blood vessel’s elastic layers. Pilar leiomyomas arise from the arrector pili muscles of the skin, and are frequently multiple.
Vascular leiomyomas (angioleiomyoma, angiomyomas) are one of the classic five painful cutaneous nodules of the skin, remembered by the mnemonic “ANGEL”. These lesions are: Angiolipoma, Neuroma (traumatic), Glomus tumor, Eccrine Spiradenoma, Leiomyoma (vascular).
