Huge pedunculated angiomyofibroblastoma of the vulva

Angiomyofibroblastoma as a rare cause of vulvar mass: A case report and literature review

Key Clinical Message

Angiomyofibroblastoma is a benign soft tissue tumor and a form of genital stromal mesenchymal tumor that primarily affects the vulva. It could possibly affect the reproductive-aged women's lower genital tract (vagina).

Abstract

Angiomyofibroblastoma is a rare benign soft tissue tumor primarily affecting the vulva in reproductive-aged women. We report a 67-year-old female complaining of a painless mass in her right vulva spreading to the right inguinal region over the past 2 years. The first clinical impression was a canal of Nuck hernia, diagnostic laparoscopy was planned to rule hernia out. The vulvar mass was excised, and a histopathology examination revealed Angiomyofibroblastoma.

Rare Vulvar Angiomyofibroblastoma: Case Series and Literature Review

Background

Angiomyofibroblastoma (AMFB) is an uncommon disease with few literature reports, leading to the poor understanding of its diagnosis, treatment, and postoperative follow-up plans among gynecologists.

Objective

To study the clinical and pathological features of vulvar AMFB and discuss its treatment and prognosis.

Case Summary

The 3 cases were characterized by a gradually increasing painless mass in the vulva. Preoperative diagnosis was difficult and mainly depended on ultrasonic examination. Immunohistochemistry confirmed clear boundaries of AMFB. This condition could be completely cured by surgery, and the prognosis was good.

Conclusion

The vulvar AMFB is a rare tumor that is frequently misdiagnosed before surgery. Ultrasound is preferred in auxiliary diagnosis, and surgery remains the best treatment, and long-term follow-up is necessary to avoid recurrence or other complications.

Practical Approach to the Diagnosis of the Vulvo-Vaginal Stromal Tumors: An Overview

Background: The category of the “stromal tumors of the lower female genital tract” encompasses a wide spectrum of lesions with variable heterogeneity, which can be nosologically classified on the basis of their morphologic and immunohistochemical profiles as deep (aggressive) angiomyxoma (DAM), cellular angiofibroma (CAF), angiomyofibroblastoma (AMFB) or myofibroblastoma (MFB). Despite the differential diagnosis between these entities being usually straightforward, their increasingly recognized unusual morphological variants, along with the overlapping morphological and immunohistochemical features among these tumours, may raise serious differential diagnostic problems. Methods and Results: The data presented in the present paper have been retrieved from the entire published literature on the PubMed website about DAM, CAF, AFMB and MFB from 1984 to 2021. The selected articles are mainly represented by small-series, and, more rarely, single-case reports with unusual clinicopathologic features. The present review focuses on the diagnostic clues of the stromal tumours of the lower female genital tract to achieve a correct classification. The main clinicopathologic features of each single entity, emphasizing their differential diagnostic clues, are discussed and summarized in tables. Representative illustrations, including the unusual morphological variants, of each single tumour are also provided. Conclusion: Awareness by pathologists of the wide morphological and immunohistochemical spectrum exhibited by these tumours is crucial to achieve correct diagnoses and to avoid confusion with reactive conditions or other benign or malignant entities.

Rare case of huge vulvar angiomyofibroblastoma in a young female

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Huge angiomyofibroblastoma of the Vulva.

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Differential diagnosis between vulvar angiomyofibroblastoma and vulvar aggressive angiomyxoma.

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Comprehensive approach diagnosing and therapy of vulvar angiomyofibroblastoma.

Mesenchymal tumours of the vulva are rare and consist of two types, difficult to distinguish but with different prognoses. Angiomyofibroblastoma (AMFB) is a benign tumour, whereas Aggressive Angiomyxoma (AA) is an infiltrating tumour. We describe a 22-year-old nulliparous patient with a vulvar mass sized 19 cm in diameter. After preoperative assessment by ultrasound, chest X-ray, and MRI, wide excision on the tumour was done and diagnosed as AMFB. Differentiation from AA is being discussed.

Application of ultrasound in aggressive angiomyxoma: Eight case reports and review of literature

Aggressive angiomyxoma (AAM) is a rare tumour that often occurs in soft tissues of the female genital tract. Eight cases of AAM are reported in this article, and the clinical features and ultrasound and magnetic resonance imaging (MRI) results of the eight cases are reviewed and summarized. The main complaints of all the patients were palpable and painless masses in the vulva or scrotum. The lesions were mainly located in the vulva, pelvis, and perineal region, with a large scope of involvement. The sonographic features of AAM were characteristic. On sonography, all of the masses were of irregular shape and showed hypoechogenicity, with a heterogeneous inner echotexture. Intratumoural and peritumoural blood flows were detected by colour Doppler imaging. On real-time ultrasonic imaging, prominent deformation of the lesions was observed by compressing the masses with the probe. Some special imaging features were also revealed, including a laminated or swirled appearance of inner echogenicity, and a finger-like or tongue-like growth pattern. On MRI imaging, the lesions showed intermediate-intensity signals and intermediate to high-intensity signals on TI-weighted and T2-weighted sequences. A rapid and uneven enhancement pattern was demonstrated. After the comparison of sonographic features with MRI and pathological findings, we found the relevance of the ultrasonographic characteristics with MRI and histological features of AAM. Ultrasound can be a valuable imaging method for the preoperative diagnosis, evaluation of scope, and follow-up of AAM.

Vaginal Angiomyofibroblastoma: A Case Report and Review of Diagnostic Imaging

Background

Angiomyofibroblastoma (AMFB) is a benign mesenchymal tumor most commonly found in the female genital tract of premenopausal women. Although rare, AMFB is an important consideration in the differential diagnosis of vulvar and vaginal masses, as it must be distinguished from aggressive angiomyxoma (AA), a locally recurrent, invasive, and damaging tumor with similar clinical and pathologic findings.

Case

We describe a patient with a 4 cm vaginal AMFB and the relevant preoperative radiographic imaging findings.

Conclusion

Preoperative diagnosis of AMFB remains difficult. Common findings on magnetic resonance imaging and transvaginal sonography are described. We conclude that both transvaginal ultrasound and MRI are potentially useful imaging modalities in the preoperative assessment of vulvar and vaginal AMFB, with more data needed to determine superiority of one modality over the other.

A Vaginal Angiomyofibroblastoma as a Rare Cause of a Prolapsing Vaginal Mass: A Case Report and Review of the Literature

Introduction

Angiomyofibroblastoma (AMFB) is a rare, benign, mesenchymal cell tumour which presents as a slow-growing mass. It is most commonly seen in the vulva and is often mistaken for Bartholin's abscess. It is histologically diagnosed by the presence of stromal cells intermingled with small blood vessels. It is morphologically similar to cellular angiofibroma and aggressive angiomyxoma, the latter of which is locally invasive and has a possibility of metastasis and a high risk of local recurrence. There is one reported case of an AMFB undergoing sarcomatous transformation.

Case Report

We report a case of a multiparous, 36-year-old woman with an anterior vaginal mass which was inappropriately treated as a vaginal prolapse prior to definitive surgical management. This is only the second reported case of an AMFB presenting as a prolapsing mass.

Angiomyofibroblastoma of the vulva diagnosed preoperatively: A case report

A 50-year-old woman (gravida 2, para 2) first noticed a small nodule in the right labium majus 2 years prior to the initial visit to the Hachinohe Red Cross Hospital (Hachinohe, Japan), which had gradually increased in size. On physical examination, a well-circumscribed, elastic, firm, goose egg-sized, subcutaneous mass protruding from the right labium majus was identified. On magnetic resonance imaging (MRI), the lesion was hypointense on T1-weighted images and was well-circumscribed, strongly enhanced and homogeneous on gadolinium-enhanced images, measuring 7.5×4 cm. The same tumor had measured 2.6 cm on an MRI performed 6 years earlier. Based on the clinical course and imaging findings, angiomyofibroblastoma was diagnosed and surgical resection of the tumor was performed. The tumor was well-circumscribed and highly vascular. The intraoperative blood loss was 70 ml. Histopathologically, the tumor cells were concentrated around blood vessels, were spindle-shaped to oval with mild atypia, and were positive for vimentin, desmin, neural cell adhesion molecule (N-CAM), CD-34, estrogen receptor and progesterone receptor, and negative for S-100. Based on these findings, the diagnosis of angiomyofibroblastoma was confirmed. Angiomyofibroblastoma is a benign mesenchymal tumor that occurs in the female external genitalia. Differentiation of this tumor from aggressive angiomyxoma, a fast-growing infiltrative malignancy that occurs in the same region, may be challenging. The diagnosis of angiomyofibroblastoma is usually based on the histopathological findings of the resected specimen. The present case is of value, as the angiomyofibroblastoma was successfully diagnosed preoperatively based on the clinical course and imaging findings.

Angiomyofibroblastoma of the Foot: a Rare Soft Tissue Tumor at Unusual Site

Angiomyofibroblastoma is a rare benign soft tissue tumor that arises predominantly in the female genital tract. It occurs less commonly in the scrotum, spermatic cord, and the retroperitoneum. Its diagnosis is based on specific histological and immunopathological features. However, the condition has never been previously described in the extremities. We present the first case report of angiomyofibroblastoma presenting as a slow-growing tumor in the foot of a 48-year-old lady.

A Rare Case of Intravesical Angiomyofibroblastoma

OBJECTIVE

To study the first reported case of intravesical angiomyofibroblastoma (AMFB). AMFB is an uncommon benign mesenchymal lesion, mostly described in the lower female genital tract, especially in the vulva and less commonly in the vagina. It is rarely seen in the male genital tract. The importance of this rare neoplasm is related to its potential mimicry of more infiltrative and prognostically less favorable lesions, such as aggressive angiomyxomas, that are found in the same anatomic area.

METHODS

A 26-year-old man presented to us with hematuria. Investigations revealed an intraluminal polypoidal lesion of approximately 92 × 77 × 76 mm within the urinary bladder. Cystoscopy revealed a large well-circumscribed tumor with a pedicle, attached to the inferolateral wall of the bladder near the bladder neck. Open exploration and en bloc excision of the bladder mass was done.

RESULTS

Histopathology and immunohistochemistry (IHC) confirmed the diagnosis of AMFB.

CONCLUSION

AMFB presents as a well-circumscribed superficial mass. Complete excision of the tumor for histopathologic and IHC examination is essential for diagnosis. This rare tumor shows morphologic similarity to some more aggressive tumors with less favorable outcome; hence, it needs to be differentiated from those. IHC is helpful but not always conclusive in the diagnosis of this rare neoplasm. This being the first-ever reported case of intravesical AMFB bears a significant importance. Careful clinical assessment, operative management, and histopathologic examination are of utmost importance in making a precise diagnosis and management of the patient.

Pedunculated angiomyofibroblastoma of the vulva: case report and review of the literature

Angiomyofibroblastoma (AMFB) is a rare benign mesenchymal tumour that occurs almost exclusively in the vulvovaginal region of women but can also occur occasionally in the inguinoscrotal region of men. It is a well-circumscribed lesion that clinically is often thought to represent a Bartholin's gland cyst and usually does not form a pedunculated mass. To our knowledge, only five cases of vulvar AMFB with pedunculated mass have been reported in the English literature and all cases involving the labia majora and middle-aged women. We report the first case of pedunculated AMFB of the vulva occurring in a young woman of 21 years old and involving the left labia minora. After excluding the most common diseases, pedunculated AMFB should be part of differential diagnosis in the workup of any pedunculated vulvar mass even in young women with a lesion involving the labia minora. We reviewed the literature and summarized all reported cases.