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BACKGROUND Angioleiomyoma is an uncommon benign soft-tissue tumor, typically found in the lower extremities. Angioleiomyoma is infrequently observed in the hand, and occurrences involving calcification are even less common. In patient with end-stage renal disease (ESRD) who receive hemodialysis, calcified angioleiomyoma can be challenging to distinguish diagnostically due to its resemblance to tumoral calcinosis. We report a unique case of calcified angioleiomyoma on the dorsum of the left hand in an ESRD patient undergoing long-term hemodialysis, focusing on clinical, imaging, and histopathological features. CASE REPORT A 46-year-old man, on maintenance hemodialysis for ESRD, presented with a painful, enlarging left-hand dorsal mass. Simple radiographs showed a well-defined soft-tissue mass with internal calcifications. Magnetic resonance imaging (MRI) revealed a well-circumscribed ovoid lesion with iso-intensity on the T1-weighted image and a heterogenous signal on the T2-weighted image, with no enhancement. He underwent complete marginal resection, and the histopathology confirmed angioleiomyoma with prominent dystrophic calcifications and positive smooth-muscle actin (SMA) immunostaining. No recurrence was seen at the 1-year follow-up. CONCLUSIONS This case highlights angioleiomyoma as a rare cause of painful hand nodules. Soft-tissue calcified masses must be differentiated from tumoral calcinosis and other benign tumors, especially in hemodialysis patients. Clinicopathologic and radiologic correlation are crucial for correct diagnosis and management.