Tsai Yi-Yen, Lu Jeng-Wei, Yen Hao, Wang Chih-Chien
Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.
Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung, Taiwan, R.O.C.
In Vivo. 2025 Jul-Aug;39(4):2485-2488. doi: 10.21873/invivo.14049.
BACKGROUND/AIM: Angiomyomas are rare benign smooth muscle tumors originating from the tunica media of blood vessel walls, most frequently affecting the lower extremities in middle-aged women.
We report the case of a 51-year-old female with a six-month history of a painful, palpable mass in the right heel. Physical examination revealed a soft, mobile, and tender subcutaneous nodule. Ultrasound imaging identified a 0.5 cm well-defined hypoechoic lesion in the subcutaneous layer, without internal blood flow, initially suspected to be an epidermoid cyst or fibrous tumor. Surgical excision of the lesion was performed, and histopathological analysis revealed a well-encapsulated tumor consisting of spindle-shaped cells with eosinophilic cytoplasm and bland nuclei, accompanied by vascular components. Immunohistochemical staining confirmed positive expression of SMA, establishing the diagnosis of angiomyoma. The patient experienced an uneventful postoperative recovery.
This case highlights the diagnostic challenges of angiomyomas, given their nonspecific clinical presentation and imaging findings. While magnetic resonance imaging may reveal characteristic features such as strong gadolinium enhancement, definitive diagnosis relies on histopathological evaluation. Clinicians should include angiomyoma in the differential diagnosis of painful subcutaneous masses in the foot and ankle, particularly in middle-aged women. Surgical excision remains the definitive diagnostic and therapeutic approach, with low recurrence rates reported.
背景/目的：血管肌瘤是一种罕见的良性平滑肌肿瘤，起源于血管壁的中膜，最常累及中年女性的下肢。
我们报告一例51岁女性病例，其右足跟出现疼痛性可触及肿块6个月。体格检查发现一个柔软、可移动且压痛的皮下结节。超声成像显示皮下层有一个0.5 cm边界清晰的低回声病变，无内部血流，最初怀疑为表皮样囊肿或纤维瘤。对该病变进行了手术切除，组织病理学分析显示为一个包膜完整的肿瘤，由具有嗜酸性细胞质和温和细胞核的梭形细胞组成，并伴有血管成分。免疫组织化学染色证实平滑肌肌动蛋白（SMA）呈阳性表达，从而确诊为血管肌瘤。患者术后恢复顺利。
鉴于血管肌瘤的临床表现和影像学表现不具有特异性，本病例突出了其诊断挑战。虽然磁共振成像可能显示出如钆增强明显等特征性表现，但明确诊断仍依赖于组织病理学评估。临床医生在足踝部疼痛性皮下肿块的鉴别诊断中应考虑血管肌瘤，尤其是中年女性。手术切除仍然是明确的诊断和治疗方法，据报道复发率较低。
