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Pathology Quiz Case 2—Diagnosis

Pathology Quiz Case 2—Diagnosis Diagnosis: Angiomyoma of the larynx Angiomyomas, or angioleiomyomas, are a vascular subtype of leiomyomas or benign smooth muscle tumors. The majority of these tumors occur in the extremities, typically as a slow-growing, firm, sometimes painful mass of the subcutis or deep dermis. The incidence of angiomyoma in the head and neck region is quite low. In a series of 562 cases, only 8.5% of angioleiomyomas were found in the head and neck region.1 Sites of occurrence that have been reported in the head and neck include the oral cavity, lower lip, auricle, submandibular region, nasal cavity, and mandible.2-4 Angiomyoma of the larynx has been reported but is exceedingly rare.5-7 Clinically, laryngeal angiomyomas can present with hoarseness, dyspnea, or globus sensation, as in our case. Pain and/or dysphagia are uncommon symptoms. Laryngeal angiomyomas are most commonly found in middle-aged and elderly men.7 They are highly vascular and can bleed significantly at biopsy. Reported tumor locations have included the vestibule, subglottis, and aryepiglottic fold, and now, in our case, the postcricoid region.6 Histopathologically, angiomyoma is characterized by thick-walled vascular spaces surrounded by and merging with mature, well-differentiated smooth muscle fiber bundles. Focal adipose tissue may also be present, as was seen in this case (Figure 2). Three histologic subtypes of angiomyoma are recognized based on the dominant histologic pattern: solid, venous, and cavernous. The case reported herein represents the cavernous subtype of angiomyoma, in which the smooth muscle in the walls of ectatic blood vessels blend with the intervening smooth muscle bundles. The results of immunohistochemical staining for smooth muscle actin and desmin support the diagnosis of angiomyoma (Figure 3 ). The distinctive histologic features limit the differential diagnosis. Angiomyoma can be distinguished from leiomyosarcoma by its lack of mitotic activity and usually small size.8 Histologically, it can appear similar to angiolipoma or angiomyolipoma. Angiolipoma, however, lacks smooth muscle. Clinically, the differential diagnosis of laryngeal angiomyoma does not routinely include angiomyolipomas, as these tumors are most commonly found in the kidneys and retroperitoneum and are often associated with tuberous sclerosis. Furthermore, angiomyolipoma can easily be distinguished by immunohistochemical staining for HMB-45.8 Figure 2. View LargeDownload Figure 3. View LargeDownload Treatment of angiomyoma of the larynx consists of complete surgical excision either via endoscopic approaches or via external approaches for very large lesions. After complete excision, recurrence is highly unlikely. However, a rare case of recurrent angiomyoma of the larynx after complete excision has been reported.7 Patients should thus be monitored for recurrence on a periodic basis after surgery. Malignant transformation of angiomyoma is highly unlikely and, to our knowledge, has never been reported. Residents and fellows in otolaryngology are invited to submit quiz cases for this section and to write letters to the ARCHIVES commenting on cases presented. Quiz cases should follow the patterns established. See "Instructions for Authors." Material for CLINICAL PROBLEM SOLVING: PATHOLOGY should be mailed to the Editor. Reprints not available from the authors. References 1. Hachisuga THashimoto HEnjoji M Angioleiomyoma: a clinicopathologic reappraisal of 562 cases. Cancer.1984;54:126-130.PubMedGoogle Scholar 2. Toida MKoizumi HShimokawa K Painful angiomyoma of the oral cavity: report of a case and review of the literature. J Oral Maxillofac Surg.2000;58:450-453.PubMedGoogle Scholar 3. Choe KSSclafani APMcCormick SA Angioleiomyoma of the auricle: a rare tumor. Otolaryngol Head Neck Surg.2001;125:109-110.PubMedGoogle Scholar 4. Kin-Hung Wong SAhuja AChow JWing-Keung King W Angioleiomyoma in the submandibular region: an unusual tumor in an unusual site. Otolaryngol Head Neck Surg.2000;122:144-145.PubMedGoogle Scholar 5. Shibata KKomune S Laryngeal angiomyoma (vascular leiomyoma): clinicopathologic findings. Laryngoscope.1980;90:1880-1886.PubMedGoogle Scholar 6. Nuutinen JSyrjanen K Angioleiomyoma of the larynx: report of a case and review of the literature. Laryngoscope.1983;93:941-943.PubMedGoogle Scholar 7. Anderson TDWeinstein GS Recurrent angiomyoma (vascular leiomyoma) of the larynx after laser excision. Otolaryngol Head Neck Surg.2000;123:646-647.PubMedGoogle Scholar 8. Kempson RLFletcher CDMEvans HLHendrickson MRSibley RK Atlas of Tumor Pathology: Tumors of the Soft Tissues. Washington, DC: Armed Forces Institute of Pathology; 1998:202, 242. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Pathology Quiz Case 2—Diagnosis

Archives of Otolaryngology - Head & Neck Surgery , Volume 130 (7) – Jul 1, 2004
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References (8)

Publisher
American Medical Association
Copyright
Copyright © 2004 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.130.7.889-b
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Abstract

Diagnosis: Angiomyoma of the larynx Angiomyomas, or angioleiomyomas, are a vascular subtype of leiomyomas or benign smooth muscle tumors. The majority of these tumors occur in the extremities, typically as a slow-growing, firm, sometimes painful mass of the subcutis or deep dermis. The incidence of angiomyoma in the head and neck region is quite low. In a series of 562 cases, only 8.5% of angioleiomyomas were found in the head and neck region.1 Sites of occurrence that have been reported in the head and neck include the oral cavity, lower lip, auricle, submandibular region, nasal cavity, and mandible.2-4 Angiomyoma of the larynx has been reported but is exceedingly rare.5-7 Clinically, laryngeal angiomyomas can present with hoarseness, dyspnea, or globus sensation, as in our case. Pain and/or dysphagia are uncommon symptoms. Laryngeal angiomyomas are most commonly found in middle-aged and elderly men.7 They are highly vascular and can bleed significantly at biopsy. Reported tumor locations have included the vestibule, subglottis, and aryepiglottic fold, and now, in our case, the postcricoid region.6 Histopathologically, angiomyoma is characterized by thick-walled vascular spaces surrounded by and merging with mature, well-differentiated smooth muscle fiber bundles. Focal adipose tissue may also be present, as was seen in this case (Figure 2). Three histologic subtypes of angiomyoma are recognized based on the dominant histologic pattern: solid, venous, and cavernous. The case reported herein represents the cavernous subtype of angiomyoma, in which the smooth muscle in the walls of ectatic blood vessels blend with the intervening smooth muscle bundles. The results of immunohistochemical staining for smooth muscle actin and desmin support the diagnosis of angiomyoma (Figure 3 ). The distinctive histologic features limit the differential diagnosis. Angiomyoma can be distinguished from leiomyosarcoma by its lack of mitotic activity and usually small size.8 Histologically, it can appear similar to angiolipoma or angiomyolipoma. Angiolipoma, however, lacks smooth muscle. Clinically, the differential diagnosis of laryngeal angiomyoma does not routinely include angiomyolipomas, as these tumors are most commonly found in the kidneys and retroperitoneum and are often associated with tuberous sclerosis. Furthermore, angiomyolipoma can easily be distinguished by immunohistochemical staining for HMB-45.8 Figure 2. View LargeDownload Figure 3. View LargeDownload Treatment of angiomyoma of the larynx consists of complete surgical excision either via endoscopic approaches or via external approaches for very large lesions. After complete excision, recurrence is highly unlikely. However, a rare case of recurrent angiomyoma of the larynx after complete excision has been reported.7 Patients should thus be monitored for recurrence on a periodic basis after surgery. Malignant transformation of angiomyoma is highly unlikely and, to our knowledge, has never been reported. Residents and fellows in otolaryngology are invited to submit quiz cases for this section and to write letters to the ARCHIVES commenting on cases presented. Quiz cases should follow the patterns established. See "Instructions for Authors." Material for CLINICAL PROBLEM SOLVING: PATHOLOGY should be mailed to the Editor. Reprints not available from the authors. References 1. Hachisuga THashimoto HEnjoji M Angioleiomyoma: a clinicopathologic reappraisal of 562 cases. Cancer.1984;54:126-130.PubMedGoogle Scholar 2. Toida MKoizumi HShimokawa K Painful angiomyoma of the oral cavity: report of a case and review of the literature. J Oral Maxillofac Surg.2000;58:450-453.PubMedGoogle Scholar 3. Choe KSSclafani APMcCormick SA Angioleiomyoma of the auricle: a rare tumor. Otolaryngol Head Neck Surg.2001;125:109-110.PubMedGoogle Scholar 4. Kin-Hung Wong SAhuja AChow JWing-Keung King W Angioleiomyoma in the submandibular region: an unusual tumor in an unusual site. Otolaryngol Head Neck Surg.2000;122:144-145.PubMedGoogle Scholar 5. Shibata KKomune S Laryngeal angiomyoma (vascular leiomyoma): clinicopathologic findings. Laryngoscope.1980;90:1880-1886.PubMedGoogle Scholar 6. Nuutinen JSyrjanen K Angioleiomyoma of the larynx: report of a case and review of the literature. Laryngoscope.1983;93:941-943.PubMedGoogle Scholar 7. Anderson TDWeinstein GS Recurrent angiomyoma (vascular leiomyoma) of the larynx after laser excision. Otolaryngol Head Neck Surg.2000;123:646-647.PubMedGoogle Scholar 8. Kempson RLFletcher CDMEvans HLHendrickson MRSibley RK Atlas of Tumor Pathology: Tumors of the Soft Tissues. Washington, DC: Armed Forces Institute of Pathology; 1998:202, 242.

Journal

Archives of Otolaryngology - Head & Neck Surgery – American Medical Association

Published: Jul 1, 2004

Keywords: angiomyoma,larynx,neoplasms

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