Angioleiomyoma (Vascular Leiomyoma) of the Oral Cavity

Abstract

A 70-year-old male presented with a slow growing, dome shaped and painless mass of the hard palate. The mass was excised. Histopathological examination confirmed the diagnosis of a angioleiomyoma (vascular leiomyoma). A leiomyoma is an uncommon benign tumor of smooth muscle differentiation. True leiomyomas of the oral cavity are rare and most oral tumors are derived from the smooth muscle of walls of blood vessels. Therefore, they are called vascular leiomyomas or angioleiomyomas. Clinically, they may resemble a myriad other conditions both benign and malignant. A definitive diagnosis depends upon histopathological examination of the biopsied tissue in correlation with the tumor cell immunohistochemistry. Tumors are excised and recurrence is rare. The histopathological findings and differential diagnosis of a case of a palatal angioleiomyoma are discussed.

Keywords: Angioleiomyoma; Leiomyoma; Oral; SMA; Tumor; Vascular.

Fig. 1

A smooth surfaced, dome-shaped, polypoid mass of the left hard palate

Fig. 2

A well-circumscribed tumor occupying the superficial connective tissue. The tumor is separated from the surface epithelium by a Grenz zone of fibro-fatty connective tissue. (H & E, 4X)

Fig. 3

Closely packed whorls and short fascicles of brightly eosinophilic spindle cells with indistinct cytoplasmic membranes. The whorls surround compressed endothelium-lined vascular channels. (H & E, 20X)

Fig. 4

The tumor cells express diffuse and strong immunohistochemical reactivity to Smooth muscle actin (SMA) (IHC, 4X)

Fig. 5

Alpha smooth muscle actin immunohistochemical reactivity of lesional cells highlights concentric whorls surrounding the compressed, endothelium-lined vascular channels. SMA positive cells are also arranged in short fascicles between the perivascular whorls (IHC, 20X)