Angioleiomyoma of the Knee: Case Series and an Unusual Cause of Knee Pain

ABSTRACT

We present a consecutive series of five patients with angioleiomyoma, a rare benign soft tissue tumor around the knee. Between 2005 and 2010, five patients with histopathologically confirmed diagnosis of angioleiomyoma of the knee underwent surgical excision. All five patients were Afro-caribbean in origin. The presenting feature was burning medial knee pain localized to a tender hyperesthetic swelling around the knee. The mean age of presentation was 45 years (range, 42 to 51 years), and the mean duration of symptom was 34 months (range, 12 to 96 months). Although magnetic resonance imaging (MRI) scans were helpful in locating and delineating the tumors, true diagnosis was established only by histopathology. All patients underwent surgical excision with complete resolution of symptoms. No recurrences were seen at an average follow-up of 16 months (range, 3 to 24 months). The treatment of these tumors, especially around the knee, is frequently delayed due to their late presentation and lack of awareness of this clinical condition. We recommend a high index of suspicion in patients, especially of Afro-caribbean origin, presenting with painful hyperesthetic subcutaneous swelling around the knee. Early investigation by MRI expedites the diagnosis, and surgical excision results in complete resolution of symptoms.

KEYWORDS

Angioleiomyoma - rare tumor - knee - Afro-caribbean

REFERENCES

• 1 Duhig J T, Ayer J P. Vascular leiomyoma: a study of 61 cases.  Arch Pathol Lab Med. 1959;  68 424-430
• 2 Enzinger F M. Soft Tissue Tumours. 3rd ed. St. Louis, MO: Mosby; 1995: 469-470
• 3 Freedman A M, Meland N B. Angioleiomyomas of the extremities: Report of a case and review of the Mayo Clinic experience.  Plast Reconstr Surg. 1989;  83 328-331
• 4 Hachisuga T, Hashimoto H, Enjoji M. Angioleiomyoma. A clinicopathologic reappraisal of 562 cases.  Cancer. 1984;  54 126-130
• 5 Gulati M S, Kapoor A, Maheshwari J. Angiomyoma of the knee joint: Value of magnetic resonance imaging.  Australas Radiol. 1999;  43 353-354
• 6 Kinoshita T, Ishii K, Abe Y, Naganuma H. Angiomyoma of the lower extremity: MR findings.  Skeletal Radiol. 1997;  26 443-445
• 7 Murty A N, Ireland J. Angiomyoma of the patellar fat pad.  Knee. 2000;  7 253-254
• 8 Okahashi K, Sugimoto K, Iwai M, Oshima M, Takakura Y. Intra-articular angioleiomyoma of the knee: A case report.  Knee. 2006;  13 330-332
• 9 Dicaprio M R, Jokl P. Vascular leiomyoma presenting as medial joint line pain of the knee.  Arthroscopy. 2003;  19 E24
• 10 Thienpont E, Geens S, Nelen G. Angioleiomyoma of the knee. A case report.  Acta Orthop Belg. 2002;  68 76-78
• 11 Al-Jabri T, Garg S, Rao S. A rare case of angioleiomyoma of the knee: A case report.  Cases J. 2009;  2 7885
• 12 Stout A P. Solitary cutaneous and subcutaneous leiomyoma.  Am J Cancer. 1937;  29 435-469
• 13 Hildreth D H. The ischemia test for glomus tumor: A new diagnostic test.  Rev Surg. 1970;  27 147-148
• 14 Enzinger F M, Weiss S W. Benign tumours of smooth muscle and glomus tumours. In: Soft Tissue Tumours. 2nd ed. St. Louis, MO: CV Mosby; 1988. 383-401 581-595
• 15 Morimoto N. Angiomyoma: A clinicopathologic study.  Med J Kagoshima Univ. 1973;  24 663-683
• 16 Martínez J A, Quecedo E, Fortea J M, Oliver V, Aliaga A. Pleomorphic angioleiomyoma.  Am J Dermatopathol. 1996;  18 409-412
• 17 Kawagishi N, Kashiwagi T, Ibe M et al.. Pleomorphic angioleiomyoma.  Am J Dermatopathol. 2000;  22 268-271
• 18 Jones P G. Angio-leiomyoma: An intramuscular lesion causing severe pain in a child. Report of a case.  J Bone Joint Surg Br. 1971;  53 310-313