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Case Reports

Abstract

A 41-year-old otherwise healthy male presented to dermatology for evaluation of an asymptomatic “bump” on the nose for 1 year. Physical examination revealed a solitary 10mm x 10mm firm, well-circumscribed, subcutaneous nodule on the right nasal wall without overlying skin changes. Ultrasound demonstrated a nonspecific subcentimeter subcutaneous mass atypical for a cyst, angiofibroma, or lipoma. Pre-biopsy differential diagnosis included epidermoid cyst, pilomatricoma, hidrocystoma,  angiofibroma, and lipoma. The patient underwent an excisional biopsy for diagnosis and treatment. Histologic examination showed a well-circumscribed, non-encapsulated smooth muscle proliferation containing numerous vessels, consistent with angioleiomyoma. Angioleiomyoma is an uncommon benign smooth muscle tumor most commonly found on the lower extremities. While it’s not difficult to diagnose by histopathology, thanks to its classic appearance and smooth muscle stains, it’s not a common head and neck tumor consideration for dermatopathologists. Angioleiomyomas most commonly present as a solitary, firm, often painful, subcutaneous nodule. Eight-nine percent of subcutaneous angioleiomyomas are localized to the lower extremity. Angioleiomyomas in the head and neck region are exceedingly rare, with less than 200 cases previously reported in the literature. When they do occur in proximity to the nose, these tumors commonly grow in the submucosal region within the nasal cavity and sinuses, and they are often reported in Otolaryngology literature, rather than Dermatology or Dermatopathology. Reports of subcutaneous nasal angioleiomyomas are exceedingly rare, 6 cases were found in our literature review. The patient healed well following his surgery without recurrence to date, as excision is usually curative for solitary angioleiomyomas.