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Li W, Chen J, Zhang E, Chen W, Hu Y, Miao C, Luo C. Characteristics and outcomes of patients with primary abdominopelvic aggressive angiomyxoma: a retrospective review of 12 consecutive cases from a sarcoma referral center. BMC Surg 2023; 23:88. [PMID: 37046258 PMCID: PMC10091617 DOI: 10.1186/s12893-023-01974-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Aggressive angiomyxoma (AAM) is a rare mesenchymal tumor that mostly arises from the pelvic and perineal soft tissues. Few studies reported its characteristics and outcomes previously due to its rarity and challenges of treatments. This study aimed to investigate the clinical characteristics as well as surgical and short-term survival outcomes of primary abdominopelvic AAM. METHODS Medical records of patients who were admitted to surgery with pathological confirmation of primary abdominopelvic AAM at Peking University International Hospital from January 2016 through December 2021 were retrospectively retrieved from our retroperitoneal tumor database. Demographics, operative outcomes and pathological findings were collected. Patients received followed-up routinely after the surgery. Survival probabilities were calculated and determined through Kaplan-Meier analysis. RESULTS A total of 12 consecutive patients (male/female 4:8) were included in this study. The median age was 45 years old. The clinical presentation varied among individuals, consisting of 2 abdominal discomforts, 4 constipations, 1 lumbago, 1 prolonged menstruation, and 1 buttock swelling. R0/R1 resection was achieved in 100% of patients. Postoperatively, 50% of patients developed various complications including 3 fistulas and 3 wound infections. No operative mortality was observed. Histopathology of all patients was suggestive of AAM. Immunohistochemistry was done with a 91.7% positive rate for estrogen and progesterone receptors. The median recurrence-free survival time was 38 months. There were no cases of deceased or presented with distal metastasis during a median of 42 months' follow-up. CONCLUSIONS The clinical manifestations of abdominopelvic AAM are mostly atypical. Surgical resection with curative intents remains the mainstay treatment of this disease, which was strongly suggested in experienced sarcoma centers due to the high probability of severe postoperative complications. In addition, long-term follow-up is necessary due to the high rate of local recurrences.
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Affiliation(s)
- Wenjie Li
- Department of Retroperitoneal Tumor Surgery, Peking University International Hospital, Beijing, 102206, China
| | - Jun Chen
- Department of Retroperitoneal Tumor Surgery, Peking University International Hospital, Beijing, 102206, China
| | - Enlong Zhang
- Department of Radiology, Peking University International Hospital, Beijing, 102206, China
| | - Weida Chen
- Department of Retroperitoneal Tumor Surgery, Peking University International Hospital, Beijing, 102206, China
| | - Yuru Hu
- Department of Retroperitoneal Tumor Surgery, Peking University International Hospital, Beijing, 102206, China
| | - Chengli Miao
- Department of Retroperitoneal Tumor Surgery, Peking University International Hospital, Beijing, 102206, China
| | - Chenghua Luo
- Department of Retroperitoneal Tumor Surgery, Peking University International Hospital, Beijing, 102206, China.
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Aggressive Angiomyxoma of the Vulva: Which Is the Best Management Strategy? Description of a Case Report and Review of Literature of the Last Ten Years. J Clin Med 2023; 12:jcm12051726. [PMID: 36902513 PMCID: PMC10003322 DOI: 10.3390/jcm12051726] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/23/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Aggressive angiomyxoma is a rare mesenchymal tumour of the genital tract with a high incidence in women of reproductive age. The aim of our work is to understand which is the best management strategy for this condition, starting from the description of a rare case report up to the performance of a narrative review of the literature. METHODS We report a case of a 46-year-old woman who came to our attention because of the growth of a 10-centimetre pedunculated, non-soft, non-tender mass of the left labium majus. She underwent surgical excision, and the histologic diagnosis was aggressive angiomyxoma. Due to a lack of tumour-free margins, radicalization surgery was carried out after three months. A review of the literature of the last ten years was performed following the PRISMA statement on MEDLINE (PubMed). We obtained data from twenty-five studies describing thirty-three cases. RESULTS Aggressive angiomyxoma is characterized by a high recurrence rate of between 36 and 72% after surgery. There is no universal consensus about hormonal therapy, and most studies (85%) describe surgical excision followed by only clinical and radiological follow-up. CONCLUSION Wide surgical excision is the gold-standard treatment for aggressive angiomyxoma, succeeded by either clinical or radiological (ultrasound or MRI) follow-up.
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Ayati E, Pesikhani MD, Karamali M, Borhan A, Pourali L. A deep giant aggressive angiomyxoma of the labia majora: A case report. Int J Surg Case Rep 2022; 96:107313. [PMID: 35716621 PMCID: PMC9213251 DOI: 10.1016/j.ijscr.2022.107313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Aggressive Angiomyxoma (AA) is an uncommon, locally infiltrative mesenchymal tumor that primarily originates from perineal and pelvic sites of women, particularly in the 4th decade of life with having an emphasized tendency for local recurrence, whereas it has a low tendency to metastasize. Patients often present with nonspecific symptoms such as painless visible mass that might be misdiagnosed with every mass in genital and pelvic sites in reproductive-age women. CASE PRESENTATION We describe a 31-year-old female presenting with an enlargement on the right labia majora. Ultrasound and magnetic resonance were carried out, and the mass was surgically excised completely and without complication. The diagnosis of AA was made based on characteristic histopathological features. The postoperative follow-up for recurrence is currently being continued. CLINICAL DISCUSSION Due to its rarity and lack of specificity in clinical and radiological examinations, the pre-operative misdiagnosis rate of AA is rather high. Hence, most cases are diagnosed on histology after initial surgical excision. Surgical management is the gold standard treatment for primary tumors; however, in case of local recurrences, treatment choices range from surgical resection to gonadotropin-releasing hormone (GnRH) agonist for tumors positive for estrogen and progesterone receptors. CONCLUSION Wide surgical resection is the gold standard treatment of AA; however, exceptions might occur due to the depth of tumor infiltration to adjacent viscera. Therefore, adjunct medical therapies can play a crucial role in treatment. In addition, long-term follow-up is necessary due to the high rate of local recurrences.
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Affiliation(s)
- Elnaz Ayati
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author at: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Tehran 1419733141, Iran.
| | - Maryam Deldar Pesikhani
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Karamali
- Department of Obstetrics and Gynecology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Armin Borhan
- Department of Pathology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Pourali
- Department of Obstetrics and Gynecology, Mashhad University of Medical Sciences, Mashhad, Iran
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Figueiredo G, O'Shea A, Neville GM, Lee SI. Rare Mesenchymal Tumors of the Pelvis: Imaging and Pathologic Correlation. Radiographics 2021; 42:143-158. [PMID: 34797733 DOI: 10.1148/rg.210049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Most pelvic tumors originate from the organs. Less commonly, tumors can arise from the various anatomic pelvic compartments and are comprised of mesenchymal tissue: muscles, connective tissue, vessels, lymphatics, and fat. Among some of the rarer entities are benign tumors (eg, angiomyxoma, cellular angiofibroma, and desmoid fibromatosis), malignant tumors (eg, sarcoma), and tumors that can manifest as benign or malignant (eg, solitary fibrous tumor or nerve sheath tumor). Because these tumors are uncommon and often manifest with nonspecific clinical features, imaging (usually MRI) is an initial step in the evaluation. Radiologists interpreting these images are asked to help narrow the differential diagnosis and assess the likelihood of malignancy for treatment planning. Thus, the MRI report should include the imaging features that would indicate the underlying tissue histology for pathologic diagnosis as well as a description of the anatomic extent and pattern of growth. The authors describe multiple locally aggressive benign and malignant mesenchymal tumors and highlight characteristic clinical and imaging features that enable the radiologist to narrow the differential diagnosis. The anatomic spaces of the pelvis are reviewed with illustrations to aid the radiologist in describing these tumors, which often span multiple pelvic compartments. Tumor appearance at T2-weighted, diffusion-weighted, and postcontrast MRI is summarized and illustrated with correlation at CT or fluorodeoxyglucose PET/CT, when available. MRI features that correspond to specific types of tissue (eg, myxoid, fibrous, or vascular) are highlighted and correlated with images from pathologic evaluation. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Gabrielle Figueiredo
- From the Department of Radiology, Maisonneuve-Rosemont Hospital, Université de Montréal, 5415 Assumption Blvd, Montreal, QC, Canada H1T 2M4 (G.F.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.O., S.I.L.); and Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (G.M.N.)
| | - Aileen O'Shea
- From the Department of Radiology, Maisonneuve-Rosemont Hospital, Université de Montréal, 5415 Assumption Blvd, Montreal, QC, Canada H1T 2M4 (G.F.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.O., S.I.L.); and Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (G.M.N.)
| | - Grace Mary Neville
- From the Department of Radiology, Maisonneuve-Rosemont Hospital, Université de Montréal, 5415 Assumption Blvd, Montreal, QC, Canada H1T 2M4 (G.F.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.O., S.I.L.); and Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (G.M.N.)
| | - Susanna I Lee
- From the Department of Radiology, Maisonneuve-Rosemont Hospital, Université de Montréal, 5415 Assumption Blvd, Montreal, QC, Canada H1T 2M4 (G.F.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.O., S.I.L.); and Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (G.M.N.)
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Dhamija E, Aswar H, Ehmad S, Barwad A, Pandey R, Rastogi S. Radio-pathological and Clinical Correlation of Aggressive Angiomyxoma: Experience of a Tertiary Care Cancer Hospital. Indian J Radiol Imaging 2021; 31:566-572. [PMID: 34790299 PMCID: PMC8590556 DOI: 10.1055/s-0041-1735913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background Aggressive angiomyxoma (AAM) is a rare mesenchymal tumor predominantly affecting the pelvis and perineum of females. Due to its variable clinical presentation, it is often misinterpreted and treated as other pathologies like Bartholin gland cyst, vulvar abscess, and hernia. The tumor is locally infiltrative, making its complete surgical removal difficult. Aim The aim of the study is to highlight and illustrate the imaging and pathological features of AAM. Materials and Methods After obtaining clearance from the Institutional Ethics Committee, a retrospective study was conducted on patients with histopathological diagnosis of AAM, presenting to the dedicated sarcoma clinic between 2016 and 2019. The demographic, clinical, radiological, pathological, and treatment details were obtained from the institute's database. The magnetic resonance imaging (MRI) and computed tomography images were reviewed to assess different imaging parameters. Follow-up imaging was assessed for residual or recurrent mass in the pelvis or perineum and distant metastasis. Results A total of four patients were included with an age range of 28 to 50 years. The baseline MRI of these four patients shows pelvic mass extending into the perineum, infiltrating along the surrounding fascial planes with the characteristic laminated appearance on T2-weighted image and gradual intense enhancement following contrast administration. All patients had residual disease post-surgery and were put on hormonal therapy. Conclusion AAMs are locally aggressive, rarely metastasizing mesenchymal tumor that has a specific predilection for the perineum and pelvis of females. MRI features like laminated or striated appearance, post-contrast enhancement, and finger-like infiltrating projections should raise the suspicion of the diagnosis on baseline imaging.
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Affiliation(s)
- Ekta Dhamija
- Departments of Radiodiagnosis, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Harshal Aswar
- Departments of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sawyer Ehmad
- Departments of Radiodiagnosis, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Departments of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rambha Pandey
- Departments of Radiation Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Rastogi
- Departments of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Anggraeni TD, Nuranna L, Luthfiyanto M, Siregar NC, Hellyanti T, Siregar TP, Alexandra L. Rare case of huge vulvar angiomyofibroblastoma in a young female. Gynecol Oncol Rep 2021; 36:100751. [PMID: 33869711 PMCID: PMC8040263 DOI: 10.1016/j.gore.2021.100751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/15/2021] [Indexed: 11/21/2022] Open
Abstract
Huge angiomyofibroblastoma of the Vulva. Differential diagnosis between vulvar angiomyofibroblastoma and vulvar aggressive angiomyxoma. 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.
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Affiliation(s)
- Tricia Dewi Anggraeni
- Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Corresponding author.
| | - Laila Nuranna
- Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Muhammad Luthfiyanto
- Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Nuryati Chairani Siregar
- Department of Pathological Anatomy, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Tantri Hellyanti
- Department of Pathological Anatomy, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | | | - Leonardo Alexandra
- Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
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A Rare Case of Vulvar Superficial Angiomyxoma in a Pediatric Patient. J Pediatr Adolesc Gynecol 2020; 33:727-729. [PMID: 32739529 DOI: 10.1016/j.jpag.2020.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/10/2020] [Accepted: 07/23/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Superficial angiomyxoma (SAM) is a rare, benign cutaneous tumor. Originally described as a component of Carney complex, it is now recognized as a sporadic condition. CASE A 7-year-old girl was referred for management of a 2.5-cm mass arising from the right labia majora. Key pathologic features included lobules of spindle-shaped cells in a myxoid matrix and prominent neutrophilic infiltrate. The cells were positive for CD34 and negative for desmin, progesterone receptor, and estrogen receptor staining. SUMMARY AND CONCLUSION This case is that of the youngest described patient with vulvar SAM. Patients should be carefully examined for manifestations of Carney complex to avoid potentially life-threatening complications. It is critical to distinguish SAM from aggressive angiomyxoma. The patient was referred to genetics and will be followed for local recurrence.
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Alomary NA, Albeeshi MZ, Al Thebaity RE, Yousef ZM, El-Boghdadly SA. Aggressive angiomyxoma persistently misdiagnosed as an obturator hernia managed with resection and hormonal therapy: case report. J Surg Case Rep 2020; 2020:rjaa330. [PMID: 32913627 PMCID: PMC7474539 DOI: 10.1093/jscr/rjaa330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022] Open
Abstract
Aggressive angiomyxoma (AA) is an uncommon mesenchymal tumor that mainly affects the perineum and pelvis in females of reproductive age. AA is commonly misdiagnosed as a Bartholin’s duct cyst, abscess or levator hernia. A 42-year-old female presented with a large, progressive and painless perineal swelling. She was initially diagnosed with an obturator hernia three times over the past 10 years and underwent multiple surgeries for recurrences. For this presentation, she underwent exploratory laparotomy. No hernia was identified. A large mass over the perineal area extending from the vulvar commissure to the anus was visualized. The diagnosis of AA was made on histopathology. Leuprolide (GnRHa) was used as hormonal therapy postoperatively. AA should be considered in any pelvic mass in a young female that recurs after excision. Prompt diagnosis will contribute toward minimizing local destruction of surrounding structures.
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Chapel DB, Cipriani NA, Bennett JA. Mesenchymal lesions of the vulva. Semin Diagn Pathol 2020; 38:85-98. [PMID: 32958293 DOI: 10.1053/j.semdp.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 02/01/2023]
Abstract
Mesenchymal lesions of the vulva include site-specific entities limited to the lower genital tract, as well as a range of non-site-specific tumors that are more common at extragenital sites. Site-specific lesions include fibroepithelial stromal polyp, cellular angiofibroma, angiomyofibroblastoma, and aggressive angiomyxoma. Non-site-specific tumors that may occur in the vulva include those of smooth muscle, skeletal muscle, vascular, neural, adipocytic, and uncertain differentiation. This review discusses both site-specific and non-site-specific vulvar mesenchymal lesions including non-neoplastic proliferations, benign neoplasms, locally aggressive neoplasms with a predilection for local recurrence, neoplasms of indeterminate biologic potential, and frankly malignant neoplasms with a high risk of distant metastasis and death. Accurate diagnosis is essential for proper management, and is facilitated by correlation with clinical findings and targeted application of immunohistochemical and molecular studies.
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Affiliation(s)
- David B Chapel
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Nicole A Cipriani
- Department of Pathology, The University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA
| | - Jennifer A Bennett
- Department of Pathology, The University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA.
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Vulvar Aggressive Angiomyxoma. J Minim Invasive Gynecol 2020; 27:1005-1006. [DOI: 10.1016/j.jmig.2019.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 11/20/2022]
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Cabanilla-Manuntag MCC, Lopez MPJ, Tampo MM, Gaston CL. Aggressive angiomyxoma presenting as an ischiorectal fossa tumour. BMJ Case Rep 2020; 13:13/4/e234093. [PMID: 32350054 DOI: 10.1136/bcr-2019-234093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This is a case of a young healthy woman who presented with left groin pain. On work-up, she was found to have a large, well-defined mass in the ischiorectal fossa with a percutaneous biopsy of only a benign mesenchymal mass. A multidisciplinary team of surgeons (ie, colorectal, orthopaedic, vascular and urological surgery) collaborated in planning and performing the extirpation of the tumour. Final histopathology identified the tumour to be an aggressive angiomyxoma, a benign tumour with a high predilection for local recurrence. The patient had an uneventful postoperative course, with maintenance of good functional status.
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Affiliation(s)
| | - Marc Paul Jose Lopez
- Surgery, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Mayou Martin Tampo
- Surgery, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Czar Louie Gaston
- Orthopedics, University of the Philippines, Philippine General Hospital, Manila, Philippines
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Aguilar-Frasco J, Ruben-Castillo C, Rodríguez-Quintero JH, Medina-Franco H. Aggressive angiomyxoma: giant recurrence successfully treated with wide excision and adjuvant therapy with GnRH analogue. BMJ Case Rep 2018; 11:11/1/e226973. [PMID: 30567120 DOI: 10.1136/bcr-2018-226973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jorge Aguilar-Frasco
- General Surgery, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Christopher Ruben-Castillo
- General Surgery, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | | | - Heriberto Medina-Franco
- General Surgery, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
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