| Diagnostic considerations |
Angioleiomyoma |
Leiomyosarcoma |
| Clinical Appearance |
Typically under 2 cm and rarely over 4 cm. Typically encapsulated [2,10]. |
Median size of 6 cm with a large range: 0.3-45 cm. Typically not encapsulated [10,15]. |
| Age |
The average age is 47 years [2]. |
The average age is 57 years [15]. |
| Gender distribution |
More common in females (roughly 2:1) [2,10]. |
Roughly even distribution with a slight male preference [16]. |
| Locality |
67% in the lower extremity (83% for women) [2]. |
Disregarding uterine cases, 48% occur in the extremities (more common in the lower extremities), 41% in abdominal or retroperitoneal, and 11% in the trunk [14,15,17]. |
| Recurrence following excision |
Less than 1% of cases [2]. |
Up to 60% of cases [18]. |
| Pain |
Up to 70% of cases for the solid subtype [2]. |
Often presents without pain [10,14]. |
| Imaging |
Generally, smaller but small size and non-aggressive lesion features do not exclude sarcoma. Isointense signal to muscle is seen on T1-weighted images and intermediate-high signal on T2-weighted images. T2 hypointense rim may be predictive of angioleiomyoma diagnosis [19]. |
Areas of internal necrosis or hemorrhage, with masses visible with computed tomography. Isointense signal to the muscle is seen on T1-weighted images and intermediate-high signal on T2-weighted images. Aggressive features, such as surrounding soft tissue invasion, larger size, and peritumoral edema/enhancement [20]. |
| Histology |
Three main subtypes [1]: solid, closely compacted smooth muscle with small vascular channels; cavernous, dilated vascular channels and less smooth muscle; venous, thick muscular walls and less compact smooth muscle bundles. |
Well-defined intersecting bundles of spindle cells with increased eosinophilic cytoplasm and elongated/hyperchromatic nuclei. Increased mitotic activity may suggest a malignant character [16]. |
