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Angioleiomyoma of the hand is a rare differential diagnosis of painful soft tissue nodule in the extremity. It arises from smooth muscle of the blood vessels and the most common symptom is pain. Imaging with magnetic resonance imaging shows characteristic features like a hypodense peripheral capsule with linear or branching internal hyperdensities on T2-weighted images, and post-contrast diffuse homogenous enhancement with a vessel leading up to the lesion. Histopathological examination shows well circumscribed fascicles of mature smooth muscle cells surrounding vascular lumina, lined by normal appearing endothelium without elastic lamina present. These cells stain positive for smooth muscle actin, desmin, vimentin, type IV collagen and S100, but stain negative for HMB-45 and ER. Angioleiomyoma is amenable for surgical resection. We report a case of painful subcutaneous nodule of hand, with radiological and histopathological findings suggestive of angioleiomyoma. We outline the clinical, radiological and histopathological features of this rare diagnosis for painful nodule of extremity.

Angioleiomyoma: a rare diagnosis of a painful subcutaneous nodule in the hand