Subtypes of Subcutaneous Angioleiomyoma on High- Resolution Color Doppler Ultrasonography along with MRI Appearances

Abstract

ALM is a rare tumor that arises from the tunica media of small arteries and veins [1]. ALM typically occurs in the cutaneous, subcutaneous tissue of the lower extremities in middle-aged women. Histological appearances show a proliferation of smooth muscle cells and vascular channels and the classification into three histological subtypes such as solid (or capillary), cavernous, and venous types has been defined [1]. The author has previously described the solid (or capillary) subtype of ALM as a painful and vascularized subcutaneous tumor, probably in close to the dermis [2] and indicated that all painful cutaneous and subcutaneous tumors including ALM used as the acronym "ENGLAND" or "LEND an EGG"[3], especially, angioleiomyoma, eccrine spiradenoma, schwannoma, and glomus tumor show vascularlized appearances on high-resolution color Doppler US [4]. Recently, US findings of ALM based on pathologic subtypes have been described [5] and Kang et al. [6] have reported ALM findings on US and MRI. In this article, the current knowledge of the characteristic vascular status of subtype of subcutaneous ALM on color and power Doppler US along with MRI appearances will be reviewed.

Acral Calcified Angioleiomyoma Along with Radiological Features

“…The author has previously described the solid (or capillary) subtype of ALM as a painful and vascularized subcutaneous tumor, probably in close to the dermis [2] and indicated that all painful cutaneous and subcutaneous tumors including ALM used as the acronym "ENGLAND" or "LEND an EGG" [3], especially, angioleiomyoma, eccrine spiradenoma, schwannoma, and glomus tumor show vascularlized appearances on high-resolution color Doppler US [4]. The author also described the subtypes of subcutaneous angioleiomyoma on high-resolution color Doppler ultrasonography along with MRI appearances [5]. In solid subtype, little vascularity and adjacent vessel features on color and power Doppler US and enhancing structures on one or both ends of the mass on magnetic resonance imaging may be a potential diagnostic findings as previously described [5].…”

“…Recently, the study using the ultra-highfrequency ultrasound in the evaluation of pediatric pilomatricoma has been reported [11]. The author usually performs US studies for dermatologic fields with a high-resolution, broad-band (5MHz-18MHz) linear transducer (Nobulus Hitachi, Ltd.Tokyo, Japan) and described several reports in the dermatologic area [2,4,5,[12][13][14][15][16][17][18][19][20][21][22][23][24].…”

“…The author has previously described the solid subtype of ALM as a painful and vascularized subcutaneous tumor [2] and indicated that all painful cutaneous and subcutaneous tumors used as the acronym "ENGLAND" or "LEND an EGG" [3] show vascularized appearances on high-resolution color Doppler US [4]. The author also indicated that little vascularity and adjacent vessel features on color and power Doppler US and enhancing structures on one or both ends of the mass on magnetic resonance imaging may be a potential diagnostic finding in solid subtype [5]. While ALMs of the fingers, toes, hands and fee as acral type, so called acral calcified ALMs have been rarely reported.…”

Characteristic Appearances of Peripheral Schwannoma on High-Resolution Ultrasonography And MRI: Comparison Between Antoni A-Dominant and Antoni B-Dominant Types

“…Recently, Yang et al [2] described that the target sign is a prominent feature on US in peripheral schwannoma. The author usually performs US studies for dermatologic fields with a high-resolution, broad-band (5MHz-18MHz) linear transducer (Nobulus Hitachi, Ltd. Tokyo, Japan) and described several studies including schwannoma [4][5][6][11][12][13][14][15][16][17][18][19][20][21][22].…”

“…The author has also mentioned that it is important to differentiate between schwannoma and angioleiomyoma (ALM) [5,6]. It has been suggested that nerve-tumor associations such as nerve-tumor position and neve-tumor transition are significant features to differentiate schwannoma from neuroma [7,8].…”