• Vascular leiomyoma
• angiomyoma

Soft tissue

Benign

Female (2:1)

Smooth muscle

• Common benign soft tissue tumour
• Peak incidence in 4th–6th decades
• Most common benign soft tissue tumour of the Lower extremity

• Small, painful subcutaneous nodule
• Pain exacerbated by cold, pressure, or menses
• Slow-growing, mobile nodule
• Rarely >2 cm in size

• Lower extremity (leg, ankle, foot) most common
• Upper extremity
• Head and neck region
• Often a subcutaneous location

• USS: Small well-circumscribed solid nodule. Hypoechoic with internal vascularity on Doppler
• MRI: well-defined with heterogeneous signal and heterogeneous enhancement

• Well-defined nodule with thick-walled vessels in smooth muscle stroma
• Three subtypes: solid (most common), cavernous, venous
• Smooth muscle cells with bland nuclei

• No recurrent genetic abnormalities
• Benign neoplasm with simple karyotype
• Actin and desmin positive; no significant atypia

• Simple marginal excision
• No need for wide margins

• Excellent - recurrence after complete excision is rare
• No malignant potential

• Pain is a cardinal feature - often out of proportion to size
• Female predominance and lower extremity location are characteristic
• Must be distinguished from leiomyosarcoma (which is rare in subcutaneous tissue)
• Simple excision is curative

No blood tests required

• Ultrasound - first-line; small hypoechoic subcutaneous nodule with internal vascularity on Doppler
• MRI - if diagnosis uncertain or deep component suspected
• Plain radiograph - not routinely required

Excision biopsy or core needle biopsy if clinical diagnosis uncertain

No staging required