Angioleiomyoma of middle finger terminal phalanx-case report and review of literature.

Abstract

Dear Sir, Leiomyomas are smooth muscle tumours with rare extremity localization and less than 10 % prevalence in hand. Of the 150 odd published cases of the hand very few have been reported in the terminal phalanx. We are reporting a case of Angioleiomyoma of terminal phalanx in a 70 year old lady of 15 years duration. The MRI showed a well circumscribed hyper intense lesion on T2 weighted image with prominent vascularity and bony erosion (Fig. 1). Under regional anesthesia and magnification with tourniquet control a curvilinear incision was made over the prominence of the lesion and it was excised along with a pseudo capsule (Fig. 2). Post operatively patient had minimal pain and the surgical wound healed satisfactorily. The histopathology showed a lesion composed of interlacing fascicles of smooth muscles surrounding vascular lumina lined by flattened epithelial cells with focal hyalinization of the stroma and fibrin thrombi in the vessels suggestive of angioleiomyoma. The first case of leiomyoma of hand was reported in 1960 by Butler et al. [1] Since then less than 200 cases has been published with very few arising in the terminal phalanx. The leiomyoma arising in the hand are nearly always vascular probably arising out of the tunica media layer of the vein. These lesions rarely show malignant degeneration or metastasis. MRI can help to differentiate between benign and malignant lesions with the benign being well circumscribed and delineated from the neurovascular structures and the malignant being ill defined and infiltrating the neurovascular bundle. Fig. 1 MRI image showing extent of tumour Fig. 2 Encapsulated tumour delivered through incision Treatment of the leiomyoma of hand is surgical excision which is usually curative. Hachisuga et al. [2] reported 562 cases of leiomyoma of which 56 occurred in hand. Our case was unusual because leiomyomata are very uncommon in hand and only few cases of leiomyoma of terminal phalanx [3, 4] have been reported in literature. The patient had the tumor for 15 years and presented without significant bony or skin changes.