Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 3  |  Issue : 3  |  Page : 101-103

A Large Vascular Leiomyoma in Femoral Triangle


Department of General Surgery, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India

Date of Web Publication25-Jul-2016

Correspondence Address:
Dr. Bhavinder Arora
Department of General Surgery, Pt. B.D. Sharma PGIMS, Rohtak, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0820.186715

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  Abstract 

Angioleiomyoma is a benign soft-tissue vascular tumor arising from the smooth muscle of the tunica media. It is more common in females. Lower extremities, particularly the lower leg and foot, are more affected. Cutaneous vessels are common site of origin. The main vessel- the femoral vein- is a rare site for the origin for a angioleiomyoma. We present a case of a large femoral triangle angioleiomyoma arising from the femoral vein. A clinical presentation, diagnosis, and radiological and histopathological findings are discussed.

Keywords: Angioleiomyoma, femoral triangle, soft-tissue swellings, vascular leiomyoma


How to cite this article:
Arora B. A Large Vascular Leiomyoma in Femoral Triangle. Indian J Vasc Endovasc Surg 2016;3:101-3

How to cite this URL:
Arora B. A Large Vascular Leiomyoma in Femoral Triangle. Indian J Vasc Endovasc Surg [serial online] 2016 [cited 2020 Apr 7];3:101-3. Available from: http://www.indjvascsurg.org/text.asp?2016/3/3/101/186715


  Introduction Top


Angioleiomyoma or vascular leiomyoma is an uncommon benign tumor of vascular origin. It commonly arises from tunica media of vessels, particularly veins of the lower limbs.[1] Angioleiomyoma occurs more commonly in middle-aged females. Origin in the head and neck region and upper extremity is also reported. This report describes a patient with an angioleiomyoma of the femoral vein originating in the femoral triangle. Only one case of vascular leiomyoma of great saphenous vein in femoral triangle has been reported in medical literature.[2] Besides discussing the rare origin and site in femoral triangle, pathological and radiological findings are also discussed.


  Case Report Top


A 46-year-old female presented with a 10 cm non-tender, smooth, firm, mobile swelling in the right femoral triangle. The patient complained of mild pain at the site. A clinical diagnosis of sub-fascial lipoma was made. Ultrasonography revealed a solid swelling in the femoral triangle. Fine-needle aspiration cytology was reported as neurolipomatosis. The patient was advised excision and operated under regional anesthesia. A solid 10 cm mass excised [Figure 1]. The tumor was adherent to the femoral vein [Figure 2]. There was no extension into lumen of the femoral vein; it was excised easily without necessitating femoral vein repair. On gross appearance, the excised specimen was a solid, well-capsulated, gray tumor [Figure 3]. The histopathological report of the excised swelling confirmed the diagnosis of vascular leiomyoma, the histological slide showing smooth muscle proliferation around thin walled blood vessels [Figure 4].
Figure 1: Peroperative photograph of angioleiomyoma in femoral triangle

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Figure 2: Vascular leiomyoma arising from wall of femoral vein

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Figure 3: The excised angioleiomyoma

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Figure 4: Microphotograph showing smooth muscle proliferation around thin wall blood vessels

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  Discussion Top


An angioleiomyoma is generally reported to occur as a single well defined swelling, about 2 cm in diameter, occurring on the extremities. Lower extremities are more commonly affected in females. In males, both upper extremities and lower extremities are equally affected.[3] Females aged 40–60 years are known to suffer from angioleiomyoma in 50–70% of patients.[4] They can occur in skin, subcutaneous tissue and fascia with an origin in small veins.

Angioleiomyoma can be painful in 60% of patients. Pain when present is paroxysmal in nature and can be initiated by minor stimuli such as touch.[5] The differential diagnosis includes the commonly occurring swellings such as lipoma, fibroma, schwannoma, and ganglia or solitary neurofibromas.

Various views have been expressed about origin of this tumor. The most common theory is that a vascular angioleiomyoma arises from the smooth muscle in the tunica media of the veins.[6] The second theory is that angioleiomyoma is hamartoma. The third theory is that angioleiomyoma arises from the smooth muscles of a hemangioma. It was also suggested that angioleiomyoma is an example of vascular malformation rather than a true tumor.[6] Hachisuga et al. have described four clinicopathological types as capillary, venous, cavernous, and combination of these.[7] These tumors are rarely diagnosed preoperatively as the sonographic and magnetic resonance imaging (MRI) findings in these tumors are not pathognomic.[8] Most are thus diagnosed after excision on histopathological examination.[9] Simple excision is the treatment of choice.


  Conclusion Top


First, a detailed description of a large size angioleiomyoma of approximately 10 cm is given while most of the case reports describe a size of only 0.5–2.0 cm. Second, it is arising from the femoral vein which is a large diameter vein in comparison to most of angioleiomyomas arising from small diameter veins. Third, the presence of angioleiomyoma in femoral triangle is very rare that too not producing any compression symptoms. Despite the ultrasonography, MRI, and fine-needle aspiration, preoperative clinical suspicion is equally important. The concluding diagnosis of angioleiomyoma is made only after simple excision of mass and its histopathology.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Ramesh P, Annapureddy SR, Khan F, Sutaria PD. Angioleiomyoma: A clinical, pathological and radiological review. Int J Clin Pract 2004;58:587-91.  Back to cited text no. 1
    
2.
Deweese JA, Terry R, Schwartz SI. Leiomyoma of the greater saphenous vein with preoperative localization by phlebography. Ann Surg 1958;148:859-61.  Back to cited text no. 2
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3.
Gajanthodi S, Rai R, Chaudhry RK. Vascular leiomyoma of foot. J Clin Diagn Res 2013;7:571-2.  Back to cited text no. 3
    
4.
Kinoshita T, Ishii K, Abe Y, Naganuma H. Angiomyoma of the lower extremity: MR findings. Skeletal Radiol 1997;26:443-5.  Back to cited text no. 4
    
5.
Dicaprio MR, Jokl P. Vascular leiomyoma presenting as medial joint line pain of the knee. Arthroscopy 2003;19:E24.  Back to cited text no. 5
    
6.
Duhig JT, Ayer JP. Vascular leiomyoma. A study of sixtyone cases. Arch Pathol 1959;68:424-30.  Back to cited text no. 6
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7.
Hachisuga T, Hashimoto H, Enjoji M. Angioleiomyoma. A clinicopathologic reappraisal of 562 cases. Cancer 1984;54:126-30.  Back to cited text no. 7
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8.
Hwang JW, Ahn JM, Kang HS, Suh JS, Kim SM, Seo JW. Vascular leiomyoma of an extremity: MR imaging-pathology correlation. AJR Am J Roentgenol 1998;171:981-5.  Back to cited text no. 8
    
9.
Sayit E, Sayit AT, Zan E, Bakirtas M, Akpinar H, Gunbey HP. Vascular leiomyoma of an extremity: Report of two cases with MRI and histopathologic correlation. J Clin Orthop Trauma 2014;5:110-4.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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