INFECTIOUS NATURE OF ORAL ANGIOLEIOMYOMAS – A SYSTEMATIC REVIEW

Abstract

Background:
Oral angioleiomyoma is a rare benign neoplasm derived from the smooth muscle of vascular walls, representing only a minute proportion of intraoral soft-tissue tumors. Its clinical appearance is often nonspecific, frequently resembling fibrous, salivary, or vascular lesions, which makes diagnosis challenging. Histopathological confirmation, supported by immunohistochemical profiling, is essential; however, published evidence remains limited and scattered.
Objective:
To systematically review the literature on oral angioleiomyomas, focusing on their demographic and anatomical distribution, clinical presentation, histopathological and immunohistochemical characteristics, treatment approaches, and recurrence rates.
Methods:
A protocol registered with PROSPERO (CRD420251148693) guided this review, which was conducted according to PRISMA 2020 guidelines. Comprehensive searches of PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar were undertaken to identify studies describing histologically confirmed oral angioleiomyomas. Eligible designs included case reports, case series, and observational studies presenting original patient data. Information on demographics, lesion site, clinical features, histological subtype, immunohistochemical profile, treatment, and outcomes was extracted.
Results:
Five studies (three case reports and two case series) encompassing 68 patients with 80 oral angioleiomyomas met the inclusion criteria. Patient ages ranged from 27 to 80 years (mean ≈55), with a slight male predominance. Lesions occurred most often on the lips, followed by the buccal mucosa, palate, and tongue. Clinically, they presented as slow-growing, well-circumscribed submucosal nodules, typically painless and <2 cm, with colour ranging from bluish-purple to normal mucosa. Histopathology revealed interlacing fascicles of spindle-shaped smooth-muscle cells surrounding vascular channels; the venous subtype predominated, while solid, cavernous, and adipocyte-rich variants were less frequent. Immunohistochemistry consistently demonstrated diffuse smooth muscle actin, with frequent desmin and h-caldesmon expression and negative S-100 staining. All studies reported conservative excision as the treatment of choice; only one recurrence occurred after incomplete removal, and no malignant transformation was documented.
Conclusions:
Oral angioleiomyoma is an uncommon but well-characterised benign smooth-muscle tumour of the oral cavity. Although its clinical appearance can mimic a range of other lesions, histopathological evaluation with a focused immunohistochemical panel remains the diagnostic gold standard. Simple local excision provides definitive management, with recurrence exceptional when margins are clear. Larger multicentre studies with standardised reporting and long-term follow-up are warranted to refine epidemiological estimates and confirm the biological behaviour of variant subtypes.