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AJR:192, June 2009 W291

systems and pulse sequences varied. However,
all MRI was performed with a 1.5-T scanner; and
spin-echo T1-weighted (TR range/TE range, 580–
300.9/20–9.4), fast spin-echo T2-weighted (3,641–
2,500/100–91), and gadolinium-enhanced T1-
weighted images were available in all cases. Axial,
coronal, and sagittal images were obtained in five
patients; only axial and coronal images, in two
patients; and only axial and sagittal images, in one
patient. Gadolinium-enhanced T1-weighted images
were obtained in at least two orthogonal planes. The
fat-suppression technique was used for gadolinium-
enhanced T1-weighted images in all cases.
Two radiologists—one with more than 5 years
of experience in musculoskeletal radiology and
the other, a trainee—reviewed the MR images in
consensus. All lesions were assessed for anatomic
location, margination, MR signal intensity
characteristics, presence and pattern of contrast
material enhancement, and involvement of an
adjacent structure. Skeletal muscle was used as the
reference tissue for signal intensities on T1- and
T2-weighted images. The degree of enhancement
was graded subjectively but in consensus by two
radiologists as homogeneous good enhancement,
heterogeneous good enhancement, and peripheral
poor enhancement.
After imaging, all eight patients underwent
complete excision of the mass; the final diagnosis
was made on the basis of the pathology reports for
the excised specimens. Pathologic examination of
the excised specimens was performed by an
experienced pathologist. In three patients who
underwent surgery at an outside institution, histo-
pathologic slides were submitted and reviewed by
the same pathologist in our institution.
Angioleiomyoma in Soft Tissue
of Extremities: MRI Findings
Hye Jin Yoo
1
Jung-Ah Choi
1,2
Jin-Haeng Chung
3
Joo Han Oh
4
Gyung-Kyu Lee
5
Ja-Young Choi
1
Sung Hwan Hong
1
Heung Sik Kang
1,2
Yoo HJ, Choi JA, Chung JH, et al.
1
Department of Radiology and Institute of Radiation
Medicine, Seoul National University College of Medicine,
Seoul, Korea.
2
Department of Radiology, Seoul National University
Bundang Hospital, Seong Nam, 300 Gumi-dong,
Bundang-gu, Seongnam-si, Gyeonggi-do 463-707,
Korea. Address correspondence to J. A. Choi
(jacrad@radiol.snu.ac.kr).
3
Department of Pathology, Seoul National University
Bundang Hospital, Seong Nam, Gyeongi-Do, Korea.
4
Department of Orthopedic Surgery, Seoul National
University Bundang Hospital, Seong Nam, Gyeongi-Do,
Korea.
5
Department of Radiology, Hallym University College of
Medicine, Hangang Sacred Heart Hospital, Seoul, Korea.
MuscuI oskeI et aI l nagi ng · CI i ni caI Obser vati ons
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AJR 2009; 192:W291–W294
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© American Roentgen Ray Society
A
ngioleiomyoma is a benign
smooth muscle tumor that origi-
nates in the tunica media of the
veins [1, 2]. It can occur any-
where in the body but is most often seen in
the extremities, particularly the lower leg. It
can be located in the dermis, the subcutane-
ous fat, or the superficial fasciae of the ex-
tremities. The most frequent complaint is
simply of a mass. Pain, with or without ten-
derness, is manifested in approximately 60%
of patients [2–4]. Treatment usually consists
of marginal excision of the mass.
These tumors are rarely diagnosed be-
fore surgery because they are rarely evalu-
ated with cross-sectional imaging, and imag-
ing findings are not tumor-specific. Although
the literature contains sporadic reports about
this tumor, descriptions in the literature of its
MRI features are scarce.
The purpose of this study was to describe
the MRI features of angioleiomyomas that
contribute to their differential diagnosis from
other, more common, soft-tissue tumors.
Materials and Methods
We retrospectively reviewed MRI studies
and clinical records of eight patients with patho-
logically proven angioleiomyoma of the soft
tissue over a 2-year period from three institutions.
There were three women and five men whose ages
ranged from 10 to 66 years (mean, 49.7 years).
All patients presented with a chief complaint of a
slowly growing mass with or without pain.
Because imaging studies were performed at
outside institutions in three patients, the MRI
Keywords: extremities, MRI, neoplasms, soft tissue
DOI:10.2214/AJR.07.3952
Received March 6, 2008; accepted after revision
November 11, 2008.
OBjECTlVE. The purpose of our study was to describe the MRI findings of angioleio-
myoma in the soft tissue of the extremities.
CONCLU5lON. Angioleiomyoma should be considered a possible diagnosis when a
well-demarcated subcutaneous mass of isointense signal on T1-weighted images, heteroge-
neous high signal intensity on T2-weighted images with homogeneous strong enhancement,
and an adjacent tortuous vascular structure is seen in the extremities.
Yoo et al.
MRI of Angioleiomyoma
Musculoskeletal Imaging
Clinical Observations
W292 AJR:192, June 2009
Yoo et aI.
Results
Clinical and radiologic findings are sum-
marized in Table 1.
MRI showed well-defined oval or round
masses in the subcutaneous fat layer in the
extremities except in one case, in which MRI
showed a mass in the superficial fascial layer
of the back. Two cases were completely con-
fined to subcutaneous tissues without contact
or relationship with other structures. Two cas-
es exhibited bone contact and scalloping of
the cortex, reflecting the presence of a slowly
growing benign mass. The remaining mass-
es abutted the tendon sheath without definite
signal changes or invasion. All masses were
isointense or of slightly high signal intensity
compared with skeletal muscle on T1-weight-
ed MR images and showed slightly higher
signal intensity relative to skeletal muscle on
T2-weighted images (Fig. 1). Gadolinium-
enhanced T1-weighted images showed ho-
mogeneous good enhancement except in one
case, which showed only peripheral poor en-
hancement (Fig. 2). In all cases, a peripher-
al rim with low signal intensity was seen on
T1- and T2-weighted images, which corre-
sponded to a fibrous pseudocapsule on patho-
logic examination. In seven of the eight cases,
enhancing tubular structures adjacent to the
mass were observed, suggesting the presence
of a vascular structure (Fig. 1C). This could
be the vessel from which the tumor arose, but
whether it fed the mass or drained the mass
was not clearly identified on MR images.
The preoperative diagnosis was either a
giant cell tumor or a neurogenic tumor. In
five of the eight patients, the differential di-
agnosis was giant cell tumor because T1-
weighted images showed an isointense signal
compared with skeletal muscle, T2-weight-
ed images had a heterogeneous area with
low signal intensity, and the mass was in the
subcutaneous tissue contacting the tendon
sheath. In two of the eight patients, a preop-
erative diagnosis of neurogenic tumor was
made because imaging findings showed high
signal intensity on T2-weighted images.
The diagnosis of angioleiomyoma was
confirmed in all patients by means of patho-
logic review of an excisional biopsy speci-
men. The gross lesion specimen in all cases
appeared as a gray and myxoid solid mass
without necrosis, hemorrhage, or calcifica-
tion. All had a well-confined fibrous pseudo-
capsule. Microscopic examination of the
excised specimens showed smooth muscle
bundles and vascular channels surrounded
by a thin fibrous pseudocapsule (Fig. 1D).
Discussion
Angioleiomyoma is a form of leiomyoma
that usually occurs as a solitary subcutane-
ous lesion; it has a predilection for the low-
er extremities of middle-aged women [1, 2, 4,
5]. The typical lesion is a small, slowly grow-
ing, firm, and mobile nodule. Pain has been
known as the most striking clinical feature of
angioleiomyoma [2], reported in 58% of pa-
tients in the series by Hachisuga et al. [3] and
in 62% of patients from a study at the Mayo
Clinic [2]. Pain is thought be caused by the
active contraction of smooth muscle resulting
in local ischemia. An immunohistochemical
study suggested that the pain in these tumors
may be mediated by the nerve fibers in the
tumor parenchyma [6, 7]. In our study, four
(50%) of the eight patients reported pain.
Duhig and Ayer [5] suggested that prolif-
eration of smooth muscle in a hemangioma
produces an angioleiomyoma, and that fur-
ther proliferation produces a simple leio-
myoma. Other investigators suggested that
an angioleiomyoma arises from vein walls.
These lesions may be hamartomas [1, 3, 8].
Duhig and Ayer also suggest that a number
of angioleiomyomas are not true tumors but
are instances of vascular malformations.
The previously reported imaging findings
of angioleiomyoma have been nonspecific.
T2-weighted MR images showed mixed ar-
eas that were hyper- and isointense to skel-
etal muscle. Although hyperintense areas
showed strong enhancement, isointense ar-
eas on T2-weighted MR images did not show
enhancement after the IV administration of
contrast material [6]. Hwang et al. [8] sug-
gested that the smooth muscle and numer-
ous vessels corresponded to the hyperintense
areas, and the fibrous tissue appeared isoin-
tense on T2-weighted MR images. In addi-
tion, a well-defined peripheral hypointense
area on T2-weighted images showed the fi-
brous capsule [8]. One case report of MRI
findings described tortuous vascular chan-
nels surrounded by smooth muscle bundles
that corresponded to tortuous low signal in-
tensity on T1-weighted images, suggesting
the diagnosis of angioleiomyoma [9].
As described in the literature, seven of our
eight cases occurred in the extremities, more
frequently in the lower extremity in wom-
en and in the upper extremity exclusively in
men [3]. On MR images, all the masses show
signal intensity similar to that of muscle on
T1-weighted images and slightly higher sig-
nal intensity relative to muscle with a hypo-
intense peripheral rim on T2-weighted imag-
es. At microscopic examination, the presence
of tortuous vascular channels surrounded by
smooth muscle bundles and areas of myxoid
change explains the heterogeneity of signal
intensity in the tumor on T2-weighted imag-
es (Fig. 1).
TABLE 1: MRl and CIinicaI Findings of AngioIeionyona in Eight Patients
Patient
No. Sex
Age
(y) Pain Location
Size
(cm)
T1-Weighted
Signal Intensity
T2- Weighted
Signal Intensity Enhancement
Peripheral
Hypointense
Rim
a
Adjacent
Vascular
Structure
1 F 50 + Ankle 1.8 Iso- to slightly high Slightly high Homogeneous, good + +
2 F 53 – Ankle 2.5 Iso- to slightly high Slightly high Peripheral, poor + +
3 F 63 + Lower leg 2.0 Iso- Slightly high Heterogeneous, good + –
4 M 43 + Foot 2.6 Iso- Slightly high Homogeneous, good + +
5 M 66 – Wrist 2.0 Iso- High Homogeneous, good + +
6 M 47 – Wrist 2.3 Iso- High Homogeneous, good + +
7 M 66 + Wrist 2.0 Iso- High Homogeneous, good + +
8 M 10 – Back 1.5 Slightly high High Homogeneous, good + +
a
On T2-weighted images.
AJR:192, June 2009 W293
MRI of Angioleiomyoma
In one patient, the mass showed higher sig-
nal intensity on T2-weighted images than was
seen in our remaining cases. Microscopically,
areas of myxoid change and hyalinization were
predominant in this case. Loose cellularity with
edematous change may have caused the prolon-
gation of relaxation time on T2-weighted MRI.
On gadolinium-enhanced T1-weighted im-
ages, homogeneous good enhancement was
observed in all cases but one, which showed
only peripheral enhancement (Fig. 2). In the
patient having only peripheral enhancement,
fewer vessels were observed at microscopic
examination. The presence of abundant ves-
sels in the tumor in the remaining cases may
explain the marked enhancement after gad-
olinium injection. Interestingly, a vascular
structure closely abutting the mass was ob-
served on MR images in seven of the eight
patients (Fig. 1C). The histologic specimens
of these masses showed dilated vascular
A
Fig. 1—50-year-old woman with painless mass in
ankle.
A, Axial T1-weighted spin-echo MR image (TR/TE,
547/16) shows well-demarcated soft-tissue mass
(arrow) of isointense signal compared with muscle.
Mass is completely confined to subcutaneous tissue
and contacts fibula.
B, Axial T2-weighted spin-echo image (2,500/100)
shows mass (arrow) with slightly high signal
intensity.
C, Axial contrast-enhanced T1-weighted fat-
saturated image shows homogeneous enhanced
mass with adjacent vascular structure (arrowhead).
D, Photomicrograph of specimen shows numerous
vascular channels and proliferation of smooth muscle
cells. (H and E, ×100)
C
B
D
A
Fig. 2—53-year-old woman with painless mass in
ankle.
A, Axial contrast-enhanced T1-weighted fat-
saturated MR image (TR/TE, 518/17) shows
peripheral enhancement.
B, Photomicrograph of specimen shows less
abundant vascular channels than other cases in our
study. (H and E, ×100)
B
W294 AJR:192, June 2009
Yoo et aI.
channels in the peripheral area of the mass
in all patients.
In addition, in two cases there was scal-
loping of the adjacent lateral malleolar cor-
tex. This finding usually reflects the presence
of a slowly growing benign mass.
On the basis of MR findings, the differen-
tial diagnosis was either giant cell tumor or
neurogenic tumor. The MRI features of giant
cell tumor of the tendon sheath are variable
and depend on the relative proportions of fat,
fibrous tissue, and hemosiderin. Generally,
T1-weighted images show an intermediate to
low signal intensity; and on T2-weighted im-
ages the signal intensity is variable, usually
equal to or less than that of muscle. Rounded
or curvilinear regions of low signal intensity
may be seen, representing hemosiderin-lad-
en areas [10, 11], offering a different picture
from the cases in our study. Compared with
angioleiomyoma, giant cell tumor of the ten-
don also frequently shows an intimate rela-
tionship with the tendon sheath and a mul-
tilobulated appearance. Neurogenic tumors
usually present as well-demarcated masses of
high signal intensity on T2-weighted images
and usually do not exhibit a tortuous vascular
structure, such as those seen in our cases.
The major limitation of our study is the
small number of cases. Other limitations in-
clude its retrospective analytic nature and
that observers were not blinded to the diag-
nosis. Despite these limitations, we believe
our results add to a marked understanding of
the MRI appearance of angioleiomyoma.
Clinically, the major differential diagnosis
of a well-demarcated soft-tissue mass arising
in the subcutaneous tissue of the extremities
includes neurogenic tumor, giant cell tu-
mor, lipoma, and synovial sarcoma. How-
ever, angioleiomyoma should be considered
a possible diagnosis when a well-demarcat-
ed subcutaneous mass of isointense signal
on T1-weighted image, heterogeneous high
signal intensity on T2-weighted images with
homogeneous good enhancement, and an ad-
jacent tortuous vascular structure are seen in
the soft tissue of the extremities.
References
1. Stout AP. Solitary cutaneous and subcutaneous
leiomyoma. Am J Cancer 1937; 29:435–469
2. Freedman AM, Meland NB. Angioleiomyomas of
the extremities: report of a case and review of the
Mayo Clinic experience. Plast Reconstr Surg
1989; 83:328–331
3. Hachisuga T, Hashimoto H, Enjoji M. Angioleio-
myoma: a clinicopathologic reappraisal of 562
cases. Cancer 1984; 54:126–130
4. Akizawa S. Angiomyoma: an analysis of 124
cases. Jikeikai Med J 1980; 27:71–82
5. Duhig JT, Ayer JP. Vascular leiomyoma: a study
of 61 cases. Arch Pathol 1959; 68:424–430
6. Ramesh P, Annapureddy SR, Khan F, Stuaria PD.
Angioleiomyoma: a clinical, pathological and
radiological review. Int J Clin Pract 2004;
58:587–591
7. Hasegawa T, Seiki K, Yang P, Hirose T, Hizawa
K. Mechanism of pain and cytoskeletal properties
in angioleiomyomas: an immunohistochemical
study. Pathol Int 1994; 44:66–72
8. Hwang JW, Ahn JM, Kang HS, Suh JS, Kim SM,
Seo JW. Vascular leiomyoma of an extremity:
MR imaging–pathology correlation. AJR 1998;
171: 981–985
9. Kinoshita T, Ishii K, Abe Y, Naganuma H. Angio-
myoma of the lower extremity: MR findings. Skel-
etal Radiol 1997; 26:443–445
10. Blacksin MF, Ha DH, Hameed M, Aisner S. Su-
perficial soft tissue masses of the extremities. Ra-
dioGraphics 2006; 26:1289–1304
11. Kransdorf MJ, Murphey MD. Imaging of soft-
tissue tumors, 2nd ed. Lippincott Williams &
Wilkins, 2006:381–392

Hwang et al. One case report of MRI findings described tortuous vascular channels surrounded by smooth muscle bundles that corresponded to tortuous low signal intensity on T1-weighted images. 1 2 3 4 5 6 7 8 Sex F F F M M M M M Age (y) 50 53 63 43 66 47 66 10 Pain + – + + – – + – Location Ankle Ankle Lower leg Foot Wrist Wrist Wrist Back Size (cm) 1.5 2. which showed only peripheral poor enhancement (Fig. [8] suggested that the smooth muscle and numerous vessels corresponded to the hyperintense areas. firm. the differential diagnosis was giant cell tumor because T1weighted images showed an isointense signal compared with skeletal muscle. In seven of the eight cases.to slightly high Iso. These lesions may be hamartomas [1. In addition.5 T1-Weighted Signal Intensity Iso. The remaining masses abutted the tendon sheath without definite signal changes or invasion. 4. Gadoliniumenhanced T1-weighted images showed homogeneous good enhancement except in one case. but whether it fed the mass or drained the mass was not clearly identified on MR images. The diagnosis of angioleiomyoma was confirmed in all patients by means of pathologic review of an excisional biopsy specimen. all the masses show signal intensity similar to that of muscle on T1-weighted images and slightly higher signal intensity relative to muscle with a hypointense peripheral rim on T2-weighted images. 1D). 1C). All masses were isointense or of slightly high signal intensity compared with skeletal muscle on T1-weighted MR images and showed slightly higher signal intensity relative to skeletal muscle on T2-weighted images (Fig. Duhig and Ayer also suggest that a number of angioleiomyomas are not true tumors but are instances of vascular malformations. and the fibrous tissue appeared isointense on T2-weighted MR images. it has a predilection for the lower extremities of middle-aged women [1. which corresponded to a fibrous pseudocapsule on pathologic examination.0 2. All had a well-confined fibrous pseudocapsule. slowly growing. T2-weighted MR images showed mixed areas that were hyper. good Homogeneous. In all cases.3 2. 3. W292 AJR:192. The preoperative diagnosis was either a giant cell tumor or a neurogenic tumor. good Homogeneous. reported in 58% of patients in the series by Hachisuga et al. Two cases exhibited bone contact and scalloping of the cortex. As described in the literature. T2-weighted images had a heterogeneous area with low signal intensity. 7]. a peripheral rim with low signal intensity was seen on T1. 2).0 1. 5]. and that further proliferation produces a simple leiomyoma. In five of the eight patients. In our study.0 2. Discussion Angioleiomyoma is a form of leiomyoma that usually occurs as a solitary subcutaneous lesion. good Homogeneous. 8].8 2. suggesting the diagnosis of angioleiomyoma [9]. or calcification.and T2-weighted images. Pain is thought be caused by the active contraction of smooth muscle resulting in local ischemia. a well-defined peripheral hypointense area on T2-weighted images showed the fibrous capsule [8]. Pain has been known as the most striking clinical feature of angioleiomyoma [2]. poor Heterogeneous.Weighted Signal Intensity Slightly high Slightly high Slightly high Slightly high High High High High Enhancement Homogeneous. isointense areas on T2-weighted MR images did not show enhancement after the IV administration of contrast material [6]. Although hyperintense areas showed strong enhancement. Duhig and Ayer [5] suggested that proliferation of smooth muscle in a hemangioma produces an angioleiomyoma. Two cases were completely confined to subcutaneous tissues without contact or relationship with other structures. The previously reported imaging findings of angioleiomyoma have been nonspecific. On MR images. seven of our eight cases occurred in the extremities. 1). This could be the vessel from which the tumor arose. in which MRI showed a mass in the superficial fascial layer of the back. MRI showed well-defined oval or round masses in the subcutaneous fat layer in the extremities except in one case. The typical lesion is a small. In two of the eight patients. good Homogeneous. good Peripheral Hypointense Rima + + + + + + + + Adjacent Vascular Structure + + – + + + + + aOn T2-weighted images.Results Clinical and radiologic findings are summarized in Table 1. the presence of tortuous vascular channels surrounded by smooth muscle bundles and areas of myxoid change explains the heterogeneity of signal intensity in the tumor on T2-weighted images (Fig. At microscopic examination. 1). and the mass was in the subcutaneous tissue contacting the tendon sheath. Patient No. good Peripheral. enhancing tubular structures adjacent to the mass were observed. good Homogeneous. and mobile nodule. reflecting the presence of a slowly growing benign mass. Other investigators suggested that an angioleiomyoma arises from vein walls. Microscopic examination of the excised specimens showed smooth muscle bundles and vascular channels surrounded by a thin fibrous pseudocapsule (Fig. June 2009 . 2. more frequently in the lower extremity in women and in the upper extremity exclusively in men [3]. a preoperative diagnosis of neurogenic tumor was made because imaging findings showed high signal intensity on T2-weighted images.to slightly high IsoIsoIsoIsoIsoSlightly high T2. [3] and in 62% of patients from a study at the Mayo Clinic [2]. hemorrhage. An immunohistochemical study suggested that the pain in these tumors may be mediated by the nerve fibers in the tumor parenchyma [6. four (50%) of the eight patients reported pain. The gross lesion specimen in all cases appeared as a gray and myxoid solid mass without necrosis.and isointense to skeletal muscle.6 2. suggesting the presence of a vascular structure (Fig.

Interestingly. In the patient having only peripheral enhancement. ×100) A D A In one patient. A. a vascular structure closely abutting the mass was observed on MR images in seven of the eight patients (Fig. 2—53-year-old woman with painless mass in ankle.500/100) shows mass (arrow) with slightly high signal intensity. Loose cellularity with edematous change may have caused the prolongation of relaxation time on T2-weighted MRI. 2). Photomicrograph of specimen shows less abundant vascular channels than other cases in our study. (H and E. homogeneous good enhancement was observed in all cases but one. which showed only peripheral enhancement (Fig. On gadolinium-enhanced T1-weighted images. A. Microscopically. The presence of abundant ves- Fig. B. B. Photomicrograph of specimen shows numerous vascular channels and proliferation of smooth muscle cells. D. C. Axial T2-weighted spin-echo image (2. Axial contrast-enhanced T1-weighted fatsaturated image shows homogeneous enhanced mass with adjacent vascular structure (arrowhead).MRI of Angioleiomyoma Fig. (H and E. Axial contrast-enhanced T1-weighted fatsaturated MR image (TR/TE. The histologic specimens of these masses showed dilated vascular AJR:192. 1—50-year-old woman with painless mass in ankle. areas of myxoid change and hyalinization were predominant in this case. ×100) sels in the tumor in the remaining cases may explain the marked enhancement after gadolinium injection. fewer vessels were observed at microscopic examination. 547/16) shows well-demarcated soft-tissue mass (arrow) of isointense signal compared with muscle. the mass showed higher signal intensity on T2-weighted images than was seen in our remaining cases. Axial T1-weighted spin-echo MR image (TR/TE. 1C). 518/17) shows peripheral enhancement. Mass is completely confined to subcutaneous tissue and contacts fibula. June 2009 W293 .

83:328–331 3. However. Kinoshita T. Angiomyoma: an analysis of 124 cases. 29:435–469 2. pathological and radiological review. Annapureddy SR. Other limitations include its retrospective analytic nature and that observers were not blinded to the diagnosis. in two cases there was scalloping of the adjacent lateral malleolar cortex. 27:71–82 5. Abe Y. Murphey MD. Akizawa S. the differential diagnosis was either giant cell tumor or neurogenic tumor. The major limitation of our study is the small number of cases. T1-weighted images show an intermediate to low signal intensity. Blacksin MF. angioleiomyoma should be considered a possible diagnosis when a well-demarcated subcutaneous mass of isointense signal on T1-weighted image. 54:126–130 4. Freedman AM. Cancer 1984. Aisner S. 171: 981–985 9. Kang HS. Arch Pathol 1959. 68:424–430 6. Am J Cancer 1937. Hashimoto H. Lippincott Williams & Wilkins. Pathol Int 1994. RadioGraphics 2006.channels in the peripheral area of the mass in all patients. Generally. Hasegawa T. Angioleiomyoma: a clinical. Ramesh P. 2006:381–392 W294 AJR:192. Clinically. Int J Clin Pract 2004. This finding usually reflects the presence of a slowly growing benign mass. 11]. Seo JW. Solitary cutaneous and subcutaneous leiomyoma. and hemosiderin. Plast Reconstr Surg 1989. References 1. Vascular leiomyoma of an extremity: MR imaging–pathology correlation. The MRI features of giant cell tumor of the tendon sheath are variable and depend on the relative proportions of fat. Angiomyoma of the lower extremity: MR findings. Mechanism of pain and cytoskeletal properties in angioleiomyomas: an immunohistochemical study. Imaging of softtissue tumors. Neurogenic tumors usually present as well-demarcated masses of high signal intensity on T2-weighted images and usually do not exhibit a tortuous vascular structure. Enjoji M. Ayer JP. In addition. Ha DH. 2nd ed. Compared with angioleiomyoma. fibrous tissue. Kim SM. Kransdorf MJ. 58:587–591 7. Meland NB. 44:66–72 8. 26:443–445 10. giant cell tumor of the tendon also frequently shows an intimate relationship with the tendon sheath and a multilobulated appearance. we believe our results add to a marked understanding of the MRI appearance of angioleiomyoma. and an adjacent tortuous vascular structure are seen in the soft tissue of the extremities. Naganuma H. Hwang JW. Angioleiomyoma: a clinicopathologic reappraisal of 562 cases. Despite these limitations. giant cell tumor. Hizawa K. Ahn JM. heterogeneous high signal intensity on T2-weighted images with homogeneous good enhancement. Ishii K. lipoma. AJR 1998. Seiki K. June 2009 . Stuaria PD. Khan F. the major differential diagnosis of a well-demarcated soft-tissue mass arising in the subcutaneous tissue of the extremities includes neurogenic tumor. Duhig JT. Rounded or curvilinear regions of low signal intensity may be seen. and on T2-weighted images the signal intensity is variable. Hameed M. 26:1289–1304 11. such as those seen in our cases. Vascular leiomyoma: a study of 61 cases. Superficial soft tissue masses of the extremities. offering a different picture from the cases in our study. Hachisuga T. Stout AP. Suh JS. usually equal to or less than that of muscle. Skeletal Radiol 1997. Jikeikai Med J 1980. On the basis of MR findings. and synovial sarcoma. representing hemosiderin-laden areas [10. Hirose T. Angioleiomyomas of the extremities: report of a case and review of the Mayo Clinic experience. Yang P.