[Intermittent painattacks: a typical sign of a vascular leiomyoma]

A 54-year-old women reported on intermittent attacks of pain attacks in the tibia, that she had for the first time during her pregnancies 24 years and 17 years before, disappearing with the birth of her children. Nevertheless the pain recurred at the beginning of the climacteric and became more frequent in the subsequent years. The pain attacks were often triggered by a soft touch but they also arose spontaneously: nearly every night the patient was awakened between 1:00 and 4:00 a. m. by a pain attack lasting about 20-40 min. Special diagnostic methods such as phlebography, computed tomography, scintiscan did not show any pathologic findings, except a residual bone deformation of the tibia as a consequence of a tibia fracture 20 years before. The woman was treated continuously for about 7 years with injections and different medical and paramedical methods, with no improvement. She started to write a diary about the times and the frequency of the pain attacks. This was diagnosed as a neurotic behaviour and several sessions of psychological analysis revealed many problems in her life. Finally, an operation was performed in the painful region, revealing a white elastic tumour 0.6 cm in size, which was diagnosed on histological examination as a vascular leiomyoma. The patient was instantly free of pain and still felt well 6,5 years later. According to the literature, vascular leiomyoma is the only tumour of the soft tissue except glomus tumour that usually produces severe pain attacks.