Treatment of Uterine Angioleiomyoma
Surgical excision is the definitive treatment for uterine angioleiomyoma, with either myomectomy (if fertility preservation is desired) or hysterectomy (if childbearing is complete) being equally effective options. 1
Understanding Angioleiomyoma
Angioleiomyoma is a rare benign variant of uterine leiomyoma that originates from smooth muscle cells and contains characteristic thick-walled vessels. 1, 2 While this tumor is typically found in the skin of the lower extremities, uterine angioleiomyomas share similar morphological features. 1 These tumors are definitively benign and do not carry malignant potential. 2
Surgical Management Approach
For Women Who Have Completed Childbearing
Hysterectomy is the gold standard treatment with the highest satisfaction rates exceeding 90%, offering complete symptom elimination and zero recurrence risk. 3 This can be performed via abdominal, vaginal, or laparoscopically-assisted approaches depending on individual circumstances. 4
- Simple hysterectomy is curative and allows estrogen-only hormone replacement therapy at menopause if needed 4
- The decision should be based on symptom severity weighed against surgical risk, not on concern about malignancy 4
For Women Desiring Fertility Preservation
Myomectomy (angiomyomectomy with tumor-free margins) is the appropriate choice for women who wish to preserve their uterus or future fertility. 1, 2
- Either abdominal or laparoscopic myomectomy can be performed, with recurrence rates of 23-33% 3
- Major complication rates are approximately 2% and minor complication rates 9% in large multicenter studies 3
- Women should wait 2-3 months after myomectomy before attempting pregnancy to allow proper uterine healing 3
Important caveat: Myomectomy provides only a disease-free interval, not a definitive cure, as approximately one-third of patients experience recurrence of symptomatic leiomyomas. 4
Diagnostic Considerations
Before surgical intervention, proper imaging is essential:
- Pelvic ultrasound typically reveals the mass and can demonstrate increased vascularization 2, 5
- CT imaging may show prominent tortuous vascular-like enhancing structures within a well-demarcated soft tissue mass arising from the uterus 2
- MRI is preferred for comprehensive evaluation when available 4
The differential diagnosis includes hemangioma, angiofibroma, and angiomyofibroblastoma. 1
Medical Management Is Not Appropriate
Unlike typical uterine leiomyomas, there is no evidence supporting medical management (GnRH agonists, selective progesterone receptor modulators, or other hormonal therapies) specifically for angioleiomyomas. 1, 2 The treatment of choice remains surgical excision. 1
Outcomes and Prognosis
Both angiomyomectomy and hysterectomy have proven equally effective for treating uterine angioleiomyoma, resulting in good recovery and satisfactory outcomes. 1, 2 The choice between these procedures depends on the patient's symptoms and desire to preserve fertility. 1 Follow-up after surgical excision shows no recurrence when complete excision is achieved. 2