'Aggressive' angiomyxoma: a distinct clinical entity

Characteristics and treatment strategies of aggressive angiomyxoma in women: A retrospective review of 87 cases

Objective

Aggressive angiomyxoma (AAM) is a rare kind of soft tissue tumor. The purpose of this study is to summarize the clinical manifestations and treatment strategy of AAM in women.

Method

We searched the case reports on AAM in EMBASE, Web of Science and PubMed, China biomedical database, Wanfang database, VIP database, and China National Knowledge Internet from the start of database construction to November 2022 without any language restrictions in place. Then, the obtained case data were extracted, summarized, and analyzed.

Result

A total of 74 articles were retrieved involving 87 cases. The age ranges of onset were 2-67 years. The median age at onset was 34 years. The size of the tumor varied greatly among individuals, and about 65.5% of them were asymptomatic. MRI, ultrasound, and needle biopsy were used for diagnosis. Surgery was the primary mode of treatment, but it was prone to relapse. Gonadotropin-releasing hormone agonist (GnRH-a) might be used to reduce the tumor size before the operation and prevent recurrence after the operation. For patients who are unwilling to receive surgical treatment, GnRH-a alone could be attempted.

Conclusion

Doctors should consider the possibility of AAM in women with genital tumors. For surgery, it must be ensured that the negative surgical margin is recommended and achieved for preventing recurrence, but we should not ignore the impact of the excessive pursuit for a negative margin on the patient's reproductive function protection and postoperative recovery. Long-term follow-up is necessary regardless of whether patients receive medical treatment or surgical treatment.

Aggressive angiomyxoma of vulva in 28-years old patient: A case report of second recurrence

Introduction

Aggressive angiomyxoma is an uncommon mesenchymal tumor in women who are in reproductive age, that occurring in the pelvis and perineal zone with a high risk of local infiltration and recurrence.

Case presentation

We describe a case of a 28-year-old woman with a huge recurrent vulvar aggressive angiomyxoma.

Clinical Discussion

Our patients underwent surgery and tumor resection for two times but had relapsed every 2 years through 5 years and finally she underwent total vulvectomy. The patient received Decapeptide for 3 months to prevent tumor recurrence after surgery and to date,there has been no evidence of local recurrence.

Conclusion

Aggressive angiomyxoma is a rare tumor with high recurrence rate. The best treatment is surgical resection by experienced Gyn-oncologist in teamwork and territory Hospital.

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Aggressive angiomyxoma has a high trend to local recurrence.

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Radical surgery with wide margins is the first line of treatment.

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All patients counseled about the need for long-term surveillance.

"Gigantic aggressive angiomyxoma" of the jaws: A rare case report

Angiomyxomas are a group of rare myxoid benign mesenchymal tumors prone to local recurrences. Two types of angiomyxomas are well recognized in the literature: superficial and aggressive angiomyxoma. Aggressive angiomyxomas are relatively uncommon, poorly circumscribed, locally infiltrative myofibroblastic tumors with a specific predilection for the perineal regions and exceedingly rare in the head and neck region. To the best of our knowledge, we report the first case of a gigantic aggressive angiomyxoma occurring in both the maxilla and mandible in a 30-year-old male patient. Clinicians should carefully evaluate the clinical, radiological and histological data to derive the correct diagnosis of this myxoid intraoral soft-tissue neoplasm.

Aggressive angiomyxoma of the prostate: A case report

RATIONALE

Aggressive angiomyxoma (AAM) of the prostate should be considered as a differential diagnosis for prostatic tumor presenting with classical symptoms of benign prostatic hypertrophy.

PATIENT CONCERNS

A 55-year-old man experienced persisting symptoms of prostatic enlargement associated with urinary frequency and urgency and nocturia. Computed tomography images showed low density in the enlarged prostate.

DIAGNOSES

The diagnosis of AAM of the prostate was confirmed based on histopathological findings.

INTERVENTIONS

The patient underwent transurethral resection of the prostate.

OUTCOMES

The patient was enrolled into a watchful waiting protocol. His condition was fine without signs of recurrence on magnetic resonance imaging at the 8-month follow-up.

LESSONS

AAM of the prostate should be considered a possible cause of urinary difficulty, including retention, although this may be extremely rare. A reliable diagnosis and complete tumor removal enabled optimal treatment and prevention of tumor recurrence.

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.

Aggressive angiomyxoma of maxilla: A confounding clinical condition with rare occurrence!

The angiomyxomas are rarely reported in the head and neck region; this paper entails a case of aggressive angiomyxoma presenting as a growth in the maxillary anterior alveolar mucosa and lip region for 1 year, which was accurately identified and treated successfully by surgical excision. An attempt has been made to highlight the clinical and pathologic stand out features of this tumor with intricate emphasis, alongside a literary review.

Selective marginal resections in the management of aggressive angiomyxomas

AIM

Aggressive angiomyxomas (AA) are rare tumors, most commonly presenting in the pelvis of women of childbearing age. This study presents the results of selective marginal resection of this disease in patients managed at a single institution.

METHODS

Patients diagnosed with AA from July 2001 to July 2015 were identified from a prospectively maintained histopathology database.

RESULTS

Seventeen patients were diagnosed with AA in the study period. The median age at diagnosis was 48 years. Females were more commonly affected with a M:F of 1:8.5. The most common differential diagnoses were an ischiorectal abscess or Bartholin's cyst. Fifteen cases occurred in the pelvis, with two cases at other sites. Median maximum tumor diameter was 10 cm. Of the pelvic cases, 12 were managed operatively via perineal, abdominal, or abdominoperineal approaches. Excision was performed in a marginal fashion with minimal morbidity. Local recurrence developed in 58.3% with a median local recurrence free survival of 25 months. No patients developed metastatic disease or died from disease.

CONCLUSION

AA are rare tumors with a propensity for local recurrence. Atypical presentations of other perineal pathologies should prompt further investigation. Surgery should be reserved for symptomatic patients and is associated with low rates of morbidity. J. Surg. Oncol. 2016;114:828-832. © 2016 2016 Wiley Periodicals, Inc.

Clinicopathological Features and Treatment Analysis of Rare Aggressive Angiomyxoma of the Female Pelvis and Perineum - a Retrospective Study

The study was to evaluate the clinicopathological features of aggressive angiomyxoma (AAM) of the female pelvis and perineum and its treatments. This was a retrospective study of female patients with AAM admitted to our hospital. Clinical and pathological data were analyzed, as well as the postsurgical follow-up. Median age at initial presentation was 41 years. Thirteen patients had lesions involving adjacent organs. Eighteen patients underwent complete tumor resection, while one patient underwent partial tumor resection. The tumors were soft in texture, pink in color, and had mucus on the surface. A microscopic examination revealed that the tumors were non-encapsulated, with spindle cells and stellate cells of almost identical size loosely distributed in the myxoid stroma, and vessels of different sizes and wall thicknesses. Immunohistochemistry indicated that AAMs were strongly positive for CD34 and smooth muscle actin, moderately positive for desmin, estrogen receptors and progesterone receptor, and mostly negative for S-100. After a median follow-up of 24 months, the recurrence rate was 33.3 %. Four recurrences were in patients with positive initial margins. AAM is a slow growing, locally invasive, benign tumor. Complete resection could lead to lower recurrence rate compared with incomplete resection. Follow-up is necessary for recurrent cases with repeated surgeries. The overall prognosis could be favorable.

[Infrahyoid musculocutaneous flap with cutaneous horizontal pallet for an aggressive angiomyxoma of the internal face of the cheek]

Décrit par Wang en 1986, le lambeau musculocutané infra hyoidien est vascularisé par l'artère thyroïdienne supérieure et comporte les muscles sternohyoïdien, sternothyroïdien et le chef supérieur du muscle Omo hyoïdien. Le prélèvement horizontal de la palette cutanée ne modifie pas la fiabilité du lambeau et permet d’éviter des cicatrices supplémentaires. L'angiomyxome agressif est une tumeur mésenchymateuse développée aux dépens du tissu conjonctif avec un site de prédilection pour les parties molles du périné féminin. Cette tumeur croit progressivement mais n'est pas métastatique. Le traitement indiqué actuellement est l'exérèse chirurgicale large. La tumeur a une tendance à la récidive locale, qui est fréquente, liée à la difficulté d'une exérèse initiale complète. Nous rapportons le cas d'un angiomyxome agressif de la joue chez un patient de 63 ans, qui a été traité par chirurgie avec reconstruction par un lambeau musculocutané infra hyoidien à palette cutanée horizontale. Les aspects cliniques, histologiques et thérapeutiques de la tumeur ont été discutés.

Aggressive angiomyxomas: a comprehensive imaging review with clinical and histopathologic correlation

OBJECTIVE

Aggressive angiomyxomas are rare infiltrative mesenchymal neoplasms that commonly recur locally. The purpose of this study was to conduct a retrospective review of imaging findings of aggressive angiomyxomas with clinicopathologic correlation in 16 patients.

MATERIALS AND METHODS

CT and MRI studies and clinical data of 16 patients with histopathologic evidence of aggressive angiomyxoma who had been referred to our institutions from January 2002 through January 2012 were retrospectively reviewed. The tumors were evaluated with respect to location, morphology, attenuation or signal intensity, and enhancement characteristics.

RESULTS

The most common location was the pelvis and perineum with the mass on either side of the pelvic diaphragm (12/16, 75%). The characteristic "laminated" appearance was seen in 10 of 12 patients on MRI. Aggressive angiomyxomas showed only mild diffusion restriction and mild (18)F-FDG avidity in both of the two patients who underwent DWI and PET/CT, in keeping with histologic low-mitotic activity. Imaging features, such as collateral vessels and fingerlike growth pattern, were seen in seven of 16 (44%) aggressive angiomyxomas. Internal cystic degeneration was seen in three of 16 (19%) aggressive angiomyxomas.

CONCLUSION

The finding of a large multicompartmental tumor with a characteristic internal laminated morphology or extension on either side of the pelvic diaphragm should alert the radiologist to the possible diagnosis of aggressive angiomyxoma. Imaging features, such as large peripheral vessels and cystic degeneration are less common, but presence of these features in the background of laminated morphology should not deter the radiologist from suggesting a diagnosis of aggressive angiomyxoma.

Robotic assisted excision of retrovesical angiomyxoma in a male patient

Angiomyxoma is a rare tumour found predominantly in pelvis of young females. Less than 150 cases have been reported, more than 90% in females and only few cases in males. Its surgical excision is a big challenge and usually leads to recurrence due to incomplete excision. We report a case of retrovesical Angiomyxoma in an elderly male. The aim of this report is to highlight the rarity of this disease, especially in males, and robotic assisted excision as an evolving option of treatment.

Conservative En Bloc Surgery for Aggressive Angiomyxoma Achieves Good Local Control: Analysis of 14 Patients From a Single Institution

Background

The purpose of this study was to assess the value of conservative surgery in aggressive angiomyxoma (AA) in our institutional series.

Method

This was a retrospective review of patients with AA treated at our institution between 1999 and 2010.

Results

Fourteen consecutive patients were analyzed: 8 primary tumors and 6 recurrences. Female/male ratio was 13:1; median female age was 36 years. Median size of primary lesions was 12 cm (range, 7–17 cm). Median size of recurrences was 20.5 cm (range, 3–44 cm). Twelve patients were operated on. Two asymptomatic patients whose surgery would have been mutilating were placed under wait and see. Four patients had concomitant visceral resections because of massive infiltration. No tumor rupture was recorded on pathological examination. Margins were R0 (n = 2), R1 (n = 10), and R2 (n = 0). Seven patients (50%) received radiotherapy. Median postoperative follow-up was 69 months, and no patient was lost at follow-up. All patients operated on (primaries and recurrences) had no evidence of recurrence.

Conclusion

Conservative and planned en bloc surgery achieves good local control with low morbidity. Radiotherapy could enhance local control in advanced disease. Wait and see is an exploratory option for asymptomatic, stable, and nonprogressing AA in which surgery would be mutilating.

Aggressive angiomyxoma of the vulva: An uncommon entity

Aggressive angiomyxoma is a rare, locally invasive mesenchymal tumor occurring usually in women of reproductive age, which carries a high risk for local relapse; hence the need to differentiate it from the other mesenchymal tumors occurring in this region. We describe a case of a 44-year-old female presenting with a large pedunculated swelling on the right labia majora.

Aggressive angiomyxoma of the vulva: case report and literature review

Aggressive angiomyxoma is a rare softtissue tumour, typically occurring in the female pelvis and carrying a high risk of local infiltration and relapse. Surgery remains the first line of treatment, however some adjuvant treatments, such as gonadotrophin-releasing hormone (GnRH) agonists, have been used for primary treatment and for treatment against tumour recurrence. We describe a case of vulvar aggressive angiomyxoma in a 31-year old woman who underwent surgical excision of the tumour. Diagnosis was made on the basis of histopathological examination and positive immunohistochemical staining with oestrogen and progesterone receptors. Postsurgery, a GnRH agonist (3.75 mg triptorelin) was injected intramuscularly every month for 3 months to prevent tumour recurrence and, to date, no relapse has been observed. Whether treatment is with surgery, hormone therapy or both, it is clear that aggressive angiomyxoma requires close, long-term follow-up to monitor for disease recurrence and that the individualization of each case is essential for adequate management.

A rare benign genitourinary tumor in a Japanese male: urinary retention owing to aggressive angiomyxoma of the prostate

Close examination of a 67-year-old Japanese man, who complained of persistent nocturia, revealed that a semitransparent polypoid tumor had developed from the bladder neck to the prostatic urethra obstructing the internal urethral meatus, which resulted in excessive urinary retention and post-renal dysfunction. The tumor was resected by a transurethral procedure and a pathological examination of specimens revealed aggressive angiomyxoma (AAM) of the prostate. AAM usually develops in the intrapelvic and perineal organs of females. So far as we know, this is the second case of primary prostatic AAM reported in the English literature, and is the first case where the patient encountered urethral obstruction.

[Penoscrotal aggressive angiomyxoma]

Aggressive angiomyxoma denotes an extremely infrequent mesenchymal tumour. In virtually every case it involves genital, pelvic or perineal female structures. Cases involving male patients are extremely rare. It is a distinctive tumour with a characteristic clinical course and specific and well characterized microscopic features. The authors report an additional clinical case in a young male patient with massive scrotal and penile involvement, necessitating exeresis followed by complex reconstructive procedure implying flap and graft use. A review of the available literature concerning etiopathogenic, clinical, imagiologic, histological and differential diagnosis, therapeutic and prognostic aspects is also presented.

Aggressive angiomyxoma of the vulva: a case report and review of literature

BACKGROUND

Aggressive angiomyxoma (AA) is a rare vulvovaginal mesenchymal neoplasm with a marked tendency to local recurrence but which usually does not metastasize.

CASE REPORT

We describe a case of AA in the left labium majus pudendi in a 47-year-old woman who underwent incomplete surgical excision. Follow-up 2years later revealed no recurrence.

CONCLUSION

In the past, most authors advocated wide excision even if genitourinary and digestive tract resection were necessary. These days, a less radical surgery is recommended, but the significance of hormonal treatment and/or radiation therapy is not clear yet. Further investigation is necessary.

Aggressive angiomyxoma of the thigh

Aggressive angiomyxoma is a rare tumour that typically occurs in the perineum in women of reproductive age. A small number of cases occurring in men have been reported, all of which were located in the low pelvis, perineum or scrotum. While benign, the tumour is locally infiltrative and consequently has a high rate of local recurrence following surgery; therefore, accurate pre-operative diagnosis is important. The characteristic location of these tumours in the low pelvis or perineum has led to speculation that aggressive angiomyxomas arise from a mesenchymal cell that is unique to the perineum. We describe a case of aggressive angiomyxoma arising in the thigh of a 54-year-old man, which we believe is the first reported instance of this rare neoplasm occurring remote from the pelvis or perineum in a male patient. Cross-sectional imaging demonstrated a well-defined mass that had low density on CT and high intensity on fluid-sensitive MR sequences. Biopsy was non-diagnostic and excision was performed. At histological analysis, the tumour exhibited the characteristic features of aggressive angiomyxoma, with bland spindle cells and large, hyalinised blood vessels in a hypocellular myxoid matrix. Extensive immunohistochemical staining further supported the diagnosis. While the imaging features of these tumours are non-specific and suggestive of myxoid neoplasms, the diagnosis should be considered whenever biopsy of a myxoid-appearing mass yields hypocellular, non-diagnostic material, despite adequate sampling.

Un abcès périanal inhabituel

Aggressive angiomyxoma (AA) is a mesenchymal tumour occurring in connective tissue of the perineum or lower pelvis with a marked tendency to local recurrence but which usually does not metastasize. Only 130 cases had been reported to date. We report the case of a 58-year-old woman, presenting with a pelvi-perineal mass, which was considered to be an anal abscess. After surgical excision, an AA was diagnosed, with classical histological features (myxoid and vascular components) and which was positive for vimentin and CD34. This case report shows that clinical diagnosis of AA is difficult and that delayed diagnosis can prevent optimal treatment of these tumors.

Vulvar angiomyxoma, aggressive angiomyxoma, and angiomyofibroblastoma: an immunohistochemical and ultrastructural study

To investigate the histogenetical unifying theory of a single, pluripotential primitive cell for vulvar angiomyxoma, aggresive angiomyxoma, and angiomyofibroblastoma, an optical, immunohistochemical and ultrastructural study of a superficial angiomyxoma, aggressive angiomyxoma, and angiomyofibroblastoma was performed. These three tumors showed immunohistochemical and ultrastructural overlapping features. The results of the study suggest that these three tumor entities probably arise on a common pluripotential primitive cell located around the vessels of connective tissue, which could show the capacity for modulating its penotype toward similar but distinct mature cell types.

[Superficial angiomyxoma]

Superficial angiomyxomas are clinically variable, infrequent, benign skin lesions. They are usually located on the trunk, but can also appear on the lower limbs, head and neck. They are diagnosed histologically, and are characterized by the fact that they are poorly delimited, multinodular tumors, and by the presence of interstitial myxoid material with scanty cellularity. Treatment is through surgery, and local recurrence is possible. An associated Carney's complex must always be ruled out with superficial angiomyxoma. We present the case of a woman with a solitary, fast-growing superficial angiomyxoma.

Pelvic excision of large aggressive angiomyxoma in a woman: irradiation for recurrent disease

Aggressive angiomyxoma (AAM) is a rare tumor that preferentially involves the pelvis and perineal regions and arises from the connective tissue. Its cause and pathogenesis are unknown at present. Treatment typically involves surgery, and despite apparently complete resection, local recurrences are common. We describe a case of a large angiomyxoma of the left pelvis in a 59-year-old woman who underwent two surgical excisions. The first had been done in May 1998. She developed a local recurrence in December 1998. A palliative resection with macroscopic residuals was performed in February 2001, followed by radiation therapy with a total dose of 60 Gy. The diagnosis was revised at the time of the second operation. Initially, the tumor was diagnosed as angiomyofibroblastoma. Follow-up 3 years after the radiation treatment revealed no recurrence. The time of the local control achieved as yet is already longer than the former time to progression between the first two surgical procedures. This is, to our knowledge, the second description of a therapeutic irradiation of a recurrent AAM. Radiation therapy is able to control a recurrent AAM for at least 3 years.

Aggressive angiomyxoma of the vulva extending into the pelvis: report of two cases

Aggressive angiomyxoma is a rare soft-tissue neoplasm found mainly in the female pelvis. Approximately 130 cases have been reported in the literature to date. In most cases treatment consists of surgical resection, but local recurrence rates remain high (36-72%). Therefore, long-term follow up is necessary and magnetic resonance imaging seems to be the preferred method for detecting recurrence. We report our experience of a primary and a recurrent aggressive angiomyxoma.