Acral Angioleiomyoma With Tumoral Calcinosis: A Rare Case Report and Literature Review

Angioleiomyoma is a benign, pericytic (perivascular) neoplasm that most frequently arises in the dermis or subcutis of the lower extremities. Extensive calcification is extremely uncommon in this condition.

An 80-year-old woman presented with a 20-year history of a slowly growing, painless mass in the dorsomedial aspect of the left great toe. Physical examination revealed a 2.5-cm, firm, mobile, non-tender mass. Radiographs showed a well-demarcated, densely calcified mass. Computed tomography confirmed the presence of a calcified lesion without bone involvement. Magnetic resonance imaging (MRI) exhibited a well-defined mass with intermediate signal intensity on T1-weightwed sequences and high signal intensity on T2-weighted sequences. Peripheral low signal intensity areas correlating to the calcified portion of the mass were also observed on both T1- and T2-weighted sequences. Contrast-enhanced MRI demonstrated intense, relatively homogeneous enhancement in the non-calcified portion of the mass. The patient underwent an excisional biopsy of the lesion. Histologically, the lesion is composed of bundles of bland, well-differentiated smooth muscle cells with small slit-like vascular channels. In addition, calcium crystal deposits surrounded by aggregates of epithelioid histiocytes and multinucleated giant cells were observed. The patient had no evidence of local recurrence at the latest follow-up.

This unique case provides valuable insights into the understanding and treatment of acral calcified angioleiomyoma. Knowledge of this peculiar neoplasm is important because it can mimic a variety of benign and malignant soft-tissue tumors.