Oral angioleiomyomas: a case series and review of the literature

To characterize the clinical and microscopic features of oral angioleiomyomas (ALMs).

A retrospective search of our diagnostic oral pathology biopsy service archives was performed for ALMs diagnosed between 1989 and 2024. Additionally, a review of the literature was performed using PubMed.

There were 38 tumors in 29 males and 9 females, with a mean age of 56.8 years. The most common site of involvement was the lips, followed by the palate and buccal mucosa. While the majority of tumors were blue or purple, the color of 8 tumors was pink or normal; therefore, they were not clinically suspected to represent vascular lesions. The most common clinical impression was of a salivary gland lesion. Histologically, the venous subtype was the most frequent, followed by the solid and cavernous subtypes. Adipocytic differentiation was noted in 55.3% of tumors.

To the best of our knowledge, this is the largest series of oral ALMs reported in the literature. We found that oral ALMs commonly exhibit adipocytic differentiation. It is important for pathologists to be aware of this phenomenon in order to avoid erroneous classification as angiomyolipoma. Unlike angiomyolipoma, ALMs are not known to be associated with tuberous sclerosis.