A 77-year-old male presented to the hospital Oral Surgery “Lumps and Bumps” clinic with a painful nodule on his upper lip. The patient had been aware of it for years, but it was asymptomatic (Figure 1A). The palpable nodule was surgically removed and sent to pathology (Figure 1B). The lesion was diagnosed as an angioleiomyoma (ALM). ALM of the upper lip is a rare, benign soft tissue tumor arising from the smooth muscle cells of vascular wall. Although, most lesions are exophytic or superficially located. solid varieties of the upper lip have been documented [1]. It represents a vascular variant of leiomyoma distinguished by a prominent vascular component. While angioleiomyomas most commonly occur in the lower extremities, involvement of the oral cavity is uncommon, with the lips being one of the more frequently affected intraoral sites.
Clinically, the lesion typically presents as a small, well-circumscribed, slow-growing submucosal nodule covered by intact mucosa. It is usually painless and firm on palpation. Due to its vascular nature, the overlying mucosa may show a reddish or bluish discoloration [2]. The tumor most often affects adults between the third and sixth decades of life, with no strong gender predilection. Because of its nonspecific appearance, it may be clinically misdiagnosed as a fibroma, mucocele, hemangioma, or minor salivary gland tumor.
Definitive diagnosis relies on histopathological examination (Figure 2). Microscopy reveals interlacing bundles of spindle-shaped smooth muscle cells arranged around numerous vascular channels. Immunohistochemical staining demonstrates positivity for smooth muscle actin and often desmin, confirming smooth muscle differentiation [3]. Complete surgical excision is the treatment of choice and is usually curative. Recurrence of ALM is rare when the lesion is adequately removed, and the overall prognosis is excellent.
Angioleiomyoma of the upper lip is a rare, benign soft tissue tumor arising from the smooth muscle cells of vascular walls. It is a subtype of leiomyoma characterized by a prominent vascular component. Although angioleiomyomas most commonly occur in the lower extremities, they can occasionally present in the oral cavity, particularly on the lips. Clinically, an upper lip angioleiomyoma appears as a small, well-circumscribed, slow-growing, painless nodule beneath intact mucosa. The lesion is usually firm and may exhibit a reddish or bluish hue due to its vascular nature. It most frequently affects adults between the third and sixth decades of life.
Diagnosis is based on clinical examination and confirmed through histopathological analysis, which reveals interlacing bundles of smooth muscle cells surrounding vascular channels. Immunohistochemical staining for smooth muscle actin supports the diagnosis. Surgical excision is the treatment of choice and is typically curative, with recurrence being rare.
