Ultrasound and magnetic resonance imaging (MRI) features of angioleiomyoma

Vascular leiomyoma or angioleiomyoma is a rare benign tumor which belongs to the group of benign smooth muscle tumors. They are commonly located at the extremities, usually presented as a painful solitary lesion in the subcutaneous tissue. To date, very few reports describe its characteristics from an imaging point of view, especially their ultrasound characteristics, making it difficult to do a pre-surgical diagnosis. Our purpose is to describe the clinical, pathologic and imaging features of angioleiomyoma [ultrasound, Doppler ultrasound and magnetic resonance imaging (MRI) findings].

We retrospectively reviewed from the pathology database from Hospital Universitario Fundación Alcorcón, Madrid, Spain, the clinical histories of 139 patients who had surgical excision and histologic diagnosis of angioleiomyoma during the last 17 years, from May 31^st 2006 to April 17^th 2023. Of those patients, we focused on 50 who had soft tissue angioleiomyoma with imaging study [ultrasonography (US) and/or MRI] performed in our institution, making a descriptive cross-sectional study.

In our series, a very characteristic ultrasonographic and US Doppler pattern was found. It consists in the presence of a well defined, homogeneous and highly vascularized soft tissue tumor, sometimes with the presence of a feeding vessel.

When the described US features appear in a mobile and elastic subcutaneous slow growing tumor on an extremity, the diagnosis of angioleiomyoma should be considered as highly probable.