Systematic Review of Leiomyomas of the Upper Extremity: Evaluating the Role of Ultrasound in Preoperative Diagnosis

Leiomyomas are rare tumors that can occur in various locations, including the upper extremity. Their resemblance to other soft tissue masses can complicate diagnosis, making preoperative imaging essential. This systematic review and case review from our institution evaluates the diagnosis and treatment of upper extremity leiomyomas, with a focus on ultrasound as an underused but valuable diagnostic tool. A comprehensive search of MEDLINE, Embase, PubMed, and The Cochrane Library was conducted from inception to February 1, 2025. Data extracted included presenting symptoms, lesion location, diagnostic tools, histopathology, treatments, and patient outcomes. A total of 1268 articles were reviewed, yielding 105 manuscripts covering 212 cases of upper extremity leiomyomas. The mean age was 48.4 years, with a male predominance (60.7%). Leiomyomas were symptomatic for an average of 58.1 months prior to intervention. The most common locations were the hand and fingers (62.9%). Ganglion cysts were the most frequent misdiagnosis (25.2%). Among the 154 studies describing diagnostic imaging, only 17 (11.0%) used ultrasound while magnetic resonance imaging (MRI; n = 54, 35.1%) was the most commonly used. Surgical excision was the primary treatment, with no reported recurrences. The mean follow-up was 27.3 months. Although MRI remains the gold standard diagnostic tool for upper extremity leiomyomas, ultrasound offers a noninvasive, cost-effective, and accessible alternative. Expanding the use of ultrasound in resource-limited settings may improve early diagnosis, streamline management, and enhance outcomes. Our case demonstrates the usefulness of ultrasound examination for diagnosis and management.