Background: A ten year old male child presented with altered behaviour, low intelligence quotient and skin lesions. The child also had respiratory discomfort and palpitations. On investigation, a cardiac rhabdomyoma was located and excised. The skin lesions were ash leaf macules[1], shagreen patches and papulonodular lesions on the face and periungual region on the foot. This combination makes the diagnosis evident as tuberous sclerosis. Methods: Biopsy of the papulonodular lesions were done and histopathology revealed them as angiofibroma (adenoma sebaceum).[2] An angiofibroma by definition is supposed to have proliferation of blood vessels and fibrous tissue on microscopic examination. Results: This angiofibroma had in addition hyperplasia of sebaceous glands. A review of the literature revealed that sebaceous hyperplasia is only a secondary change in an angiofibroma.  Discussion: This case is presented here to highlight the microscopic diagnosis of angiofibroma and to state that sebaceous gland proliferation though a secondary change, can also present in angiofibromas and pathologists need not look for another diagnosis.