Aggressive angiomyxoma: case report and review of the literature. Radiol Case Rep. 2016;11:332-335. [PMID: 27920855 PMCID: PMC5128564 DOI: 10.1016/j.radcr.2016.10.006]

Vulval Aggressive Angiomyxoma in a 19 year teenager: a case report

Background

Aggressive Angiomyxoma is a benign, slowly growing, locally aggressive and recurrent tumour that occurs in the pelvic-perineal region of females in their reproductive years. It presents as a painless, soft, gelatinous mass and metastasizes rarely. Suspicion can be made based on clinical examination and radiological imaging but final diagnosis is confirmed only after histopathology and immunohistochemistry. The choice of treatment is surgical wide local excision.

Case presentation

We hereby present a case of a 19-year, unmarried lady, with a body mass index of 21 kg/m², who presented with a chief complaint of painless mass in left vulva which progressively increased in size in the past one year. Clinical examination revealed a large, cauliflower like, exophytic mass of 10 cm × 10 cm size. Radiological imaging confirmed involvement of lymph nodes. Wide local excision with adequate tumour free margin and depth was used as a treatment modality. The diagnosis was confirmed via histopathological examination of the excised specimen. There is no recurrence in the patient up to date.

Conclusion

Aggressive Angiomyxoma is a rare tumour and it is most often misdiagnosed. This report highlights the importance of considering Aggressive Angiomyxoma as a differential diagnosis of vulval masses and the two-step surgical approach for its treatment in low resource setting.

Plexiform fibromyxoma: Review of rare mesenchymal gastric neoplasm and its differential diagnosis

Plexiform fibromyxoma (PF) is a very rare mesenchymal neoplasm of the stomach that was first described in 2007 and was officially recognized as a subtype of gastric mesenchymal neoplasm by World Health Organization (WHO) in 2010. Histologically, PF is characterized by a plexiform growth of bland spindle to ovoid cells embedded in a myxoid stroma that is rich in small vessels. The lesion is usually paucicellular. While mucosal and vascular invasion have been documented, no metastasis or malignant transformation has been reported. Its pathogenesis is largely unknown and defining molecular alterations are not currently available. There are other mesenchymal tumors arising in the gastrointestinal tract that need to be differentiated from PF given their differing biologic behaviors and malignant potential. Histologic mimics with spindle cells include gastrointestinal stromal tumor, smooth muscle tumor, and nerve sheath tumor. Histologic mimics with myxoid stroma include myxoma and aggressive angiomyxoma. Molecular alterations that have been described in a subset of PF may be seen in gastroblastoma and malignant epithelioid tumor with glioma-associated oncogene homologue 1 (GLI1) rearrangement. The recent increase in publications on PF reflects growing recognition of this entity with expansion of clinical and pathologic findings in these cases. Herein we provide a review of PF in comparison to other mesenchymal tumors with histologic and molecular resemblance to raise the awareness of this enigmatic neoplasm. Also, we highlight the challenges pathologists face when the sample is small, or such rare entity is encountered intraoperatively.

Clinicopathologic and treatment features of aggressive angiomyxoma: a case report

OBJECTIVE

The present study is to accumulate clinicopathologic and treatment data on aggressive angiomyxoma (AA), a rare tumor.

METHODS

Various clinical findings were analyzed in 9 patients with AA at Affiliated Tumor Hospital of Xinjiang Medical University from 1996 to 2016.

RESULTS

Nine patients (8 females and 1 male) were included in the present study, with an age range from 14 to 63 years (median age, 33.4 years). The sites of tumor in 6 cases were perineum and vagina, right breast, left pelvic peritoneum and right groin (male). Gross examination showed that the tumor was solid and soft, with unclear boundary but no capsule. The cut surface was gray and jelly-like. According to microscopic examination, the tumor had invasive growth, and small fusiform or star-shaped cells being dispersed in a myxoid background, enclosing several capillary structures with a thin wall. The initial treatment was localized excision. Follow-up showed that 2 patients died from cardiovascular and cerebrovascular disease, 2 patients had local recurrence, 2 patients were withdrawn, and others had neither local recurrence nor distant metastasis. Follow-up time was 3-25 years.

CONCLUSION

AA is a rare tumor that occurs predominantly in females. Local resection is appropriate to manipulate the tumor, and local recurrence is common.

Surgical Resection of Retroperitoneal Aggressive Angiomyxoma: Case Report and Review of the Literature

Aggressive angiomyxoma is a benign stromal tumor with a higher prevalence in middle-aged women. The objective of this case report is to illustrate the aggressive clinical behavior of this benign tumor. We present the case of a 45-year-old female patient, with tumor recurrence after multiple surgical resections of a pelvis-subperitoneal angiomyxoma. Surgical excision of the tumor, with extensive pelvic dissection and organ resection, was performed. The 12-month follow-up showed no tumor recurrence. Based on this case, and the published literature we may conclude that surgical resection represents the main treatment of aggressive angiomyxoma, even though it is associated with significant morbidity and a poor local control of the tumor.