Smooth muscle tumors are benign tumors originating from smooth muscle tissues, mostly occurring in the uterus and digestive tract; however, smooth muscle tumors occurring in the perianal sphincter are very rare. A 48-year-old woman presented with perianal swelling and pain and was misdiagnosed with a perianal abscess after examination at a foreign hospital. Upon further examination, the patient was diagnosed with a perianal smooth muscle tumor, with a size of approximately 6.5 × 5.5 × 4 cm. We succeeded in surgically removing the tumor. The patient was followed up for 2 years after the operation, and her anus functioned well without recurrence. Perianal abscess and perianal smooth muscle tumors are difficult to differentiate in the clinic and need to be identified via imaging. In clinical practice, smooth muscle tumors should be differentiated from perianal abscess and diseases such as rectal mesenchymal tumors and smooth muscle sarcomas.

Angioleiomyoma, a vascular leiomyoma is a rare, benign smooth-muscle tumor observed to occur anywhere in the body, most frequently in the lower extremities but very rarely in the digestive system. Angioleiomyoma in the hindgut is infrequent and in particular, rectal/perianal location has been observed very rarely.

We describe herein a case of a 50-year-old male patient complaining of perineal discomfort and a swelling at the level of the left ischio-rectal fossa, moderately painful. This solid mass in the left ischio-rectal space was in close relationship with the wall of the ano-rectal junction. After surgical removal and histopathology, the mass resulted an angioleiomyoma, vascular type, desmin positive, a very rare neoplasm. Extensive immune-histochemical studies are fundamental for the correct diagnosis and to rule out other mesenchymal tumors.

Angioleiomyoma is a very rare neoplasm of the gastrointestinal tract, and the fundamental problem of peri-rectal/perianal angioleiomyoma is represented by differential diagnosis from gastrointestinal stromal tumors (GISTs) and other perianal/perirectal swellings. For correct differential diagnosis, the histopathology supported by extensive immune-histochemical study adopting a panel of specific tissue markers is important. The surgical treatment is mandatory with complete excision and subsequent follow-up since local recurrence may occur.

Angioleiomyoma (ALM) is a rare benign perivascular (pericytic) tumor primarily composed of well-differentiated smooth muscle and vascular components. Its clinical and radiological features lack specificity, making diagnosis challenging and prone to misdiagnosis. This report summarizes the clinical data of a patient treated at our hospital who was preoperatively misdiagnosed with rectal cancer but was subsequently found to have perirectal ALM. Additionally, a review of the relevant literature is provided.

Angioleiomyoma is a rare and benign stromal tumor typically found in subcutaneous tissue. It rarely occurs in the gastrointestinal tract. Among the reported cases, the most common complication was gastrointestinal bleeding. Perforation has only been reported as a complication in the last few decades.

This case report detailed the discovery of intestinal angioleiomyoma in a 47-year-old male presenting with abdominal pain that had persisted for 3 d. After suspecting hollow organ perforation, surgical intervention involving intestinal resection and anastomosis was performed.

The report underscores the significance of early surgical intervention in effectively treating angioleiomyoma while emphasizing the pivotal role of timely and appropriate measures for favorable outcomes.

Angioleiomyomas are rare benign tumors, which take origin from smooth muscle fibers of the tunica media of veins. Even though angioleiomyomas can appear anywhere in the body, these masses are rarely occurred in the gastrointestinal system. This is the first reported case of perianal angioleiomyomas, where the tumor in close relation with the anal canal was investigated with endoanal ultrasonography. Local excision of such lesion is generally curative.

Angioleiomyomas are benign smooth muscle tumors that originate from the tunica media of veins and arteries. They can occur anywhere in the body, but the preferential location of these tumors is the lower extremities. We describe a rare case of rectal angioleiomyoma and present our findings obtained by using computed tomography, magnetic resonance imaging, and histopathological analysis.