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Dash B, Rath S, Rekhi B, Mittal N, Kulkarni R, Shylasree T, Maheshwari A. Vulvo-vaginal stromal tumours - Case series of a rare entity from an oncology centre in India. Gynecol Oncol Rep 2024; 55:101464. [PMID: 39184280 PMCID: PMC11342898 DOI: 10.1016/j.gore.2024.101464] [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: 04/22/2024] [Revised: 06/17/2024] [Accepted: 07/14/2024] [Indexed: 08/27/2024] Open
Abstract
Vulvo-vaginal stromal tumours are a rare and diverse group of mesenchymal neoplasms unique to hormone-responsive stroma of the vulva and vagina. These tumours are mostly benign, except for the locally aggressive deep angiomyxomas. Often these tumours pose diagnostic challenges, resembling certain malignant vulvo vaginal tumours. This case series highlights clinicopathological features of four angiomyxomas; a single angiomyofibroblastoma, and another superficial myofibroblastoma, including their clinical outcomes. All patients were in their 4th or 5th decade of life. Only 1/4 angiomyxomas was correctly diagnosed at the referring hospitals. Three out of four patients harbouring angiomyxomas achieved clinical remission post-surgery, while one patient was lost to follow-up. By immunohistochemistry, tumor cells showed variable positivity for desmin, SMA, ER, and PR, and negativity for S100P and CD34. The angiomyofibroblastoma was initially misdiagnosed as a liposarcoma, and the patient was lost to follow-up after diagnosis. Immunohistochemically, the tumor cells were diffusely positive for SMA and ER; weakly and focally positive for desmin, and negative for AE1/AE3, CD34, and S100P. The patient with superficial myofibroblastoma is in clinical remission post-excision with an 18-month follow-up. Immunohistochemically, the tumor cells showed CD34 positivity. Therapeutically, none of the patient received adjuvant treatment, except for a single patient with angiomyxoma, who underwent chemoradiation for a synchronous cancer cervix post-surgery. This case series provides valuable insights into the clinical heterogeneity, diagnostic intricacies, and outcomes of vulvo-vaginal stromal tumours from an oncology centre in India, further contributing to a better understanding of these rare tumours.
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Affiliation(s)
- Biswajit Dash
- Department of Surgical Oncology, Gynecologic Oncology Division, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sushmita Rath
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rohini Kulkarni
- Department of Surgical Oncology, Gynecologic Oncology Division, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - T.S. Shylasree
- Department of Surgical Oncology, Gynecologic Oncology Division, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Gynaecological Oncology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB252ZN, UK
| | - Amita Maheshwari
- Department of Surgical Oncology, Gynecologic Oncology Division, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
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Dellino M, Magazzino F, Domenici L, Cicogna S, Miano ST, Pignata S, Mangili G, Cormio G. Aggressive Angiomyxoma of the Lower Female Genital Tract: A Review of the MITO Rare Tumors Group. Cancers (Basel) 2024; 16:1375. [PMID: 38611053 PMCID: PMC11011140 DOI: 10.3390/cancers16071375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/12/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open
Abstract
Aggressive angiomyxoma (AAM) is a rare, locally aggressive, myxoid mesenchymal neoplasm primarily found in the pelvic and perineal regions of young adult females. It is a slow growing and locally infiltrating tumor. Preoperative diagnosis is difficult due to the rarity of these tumors and absence of characteristic signs and symptoms. The primary management is tumor excision. Incomplete excision is common because of the infiltrating nature of the neoplasm and absence of a definite capsule. Other non- surgical modalities have been employed, such as radiotherapy, embolization, GnRH analogues or other anti-estrogenic agents. Local relapses occur in 30-40% of the cases, and often appear many years (sometimes decades) after the first excision. Occasional distant metastasis has also been reported. A limited number of cases have been reported in the literature, mostly in the form of small case series or isolated case reports. Therefore, the aim of this paper by a team of experts from the MITO rare tumors group is to review clinical findings, pathologic characteristics and outcome of patients affected by this rare condition in order to be able to offer up-to-date guidance on the management of these cases.
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Affiliation(s)
- Miriam Dellino
- Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Francescapaola Magazzino
- Complex Operating Unit Ginecologia E Ostetricia, Ospedale Civile Di San Dona’ Di Piave (Venezia), Aulss4 Veneto Orientale, 30027 San Donà di Piave, Italy;
| | - Lavinia Domenici
- Division of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56126 Pisa, Italy;
| | - Stefania Cicogna
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34145 Trieste, Italy;
| | - Salvatora Tindara Miano
- Complex Operating Unit of Oncology, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy;
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS ‘Fondazione G Pascale’, 80144 Napoli, Italy;
| | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Gennaro Cormio
- Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
- Gynecologic Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy
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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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Ambrose NP, Coelho VV, Roopavathana B, Chase S. Recurrent perineal aggressive angiomyxoma: dilemma in diagnosis and outcome of this rare disease. BMJ Case Rep 2021; 14:14/2/e238722. [PMID: 33619134 PMCID: PMC7903107 DOI: 10.1136/bcr-2020-238722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aggressive angiomyxoma (AAM) is a very rare, benign, locally infiltrative mesenchymal tumour with a high chance of recurrence following surgical excision. In the male population, it is so rare that less than only 50 cases have been reported so far. We present a case of a large recurrent perineal AAM in a man who presented with swelling in the perineal region following surgical excision 3 years ago. After evaluation, the diagnostic dilemma of a possible perineal hernia or recurrence remained. Surgical exploration ruled out hernia and the tumour was excised with difficulty. Immunohistochemical examination showed tumour cells with diffuse nuclear positivity for oestrogen receptor and patchy cytoplasmic positivity for desmin (A2). Histological and immunohistochemical features confirmed the diagnosis. Being very rare, AAMs need to be considered as a differential diagnosis of pelvic/perineal tumours among males. With no standardised therapy for AAM, complete resection would be the goal of therapy.
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Affiliation(s)
- Nitin Paul Ambrose
- General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Victor Vijay Coelho
- General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Beulah Roopavathana
- General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Suchita Chase
- General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Robotic extralevator excision of a retrorectal giant aggressive angiomyxoma. Obstet Gynecol Sci 2018; 61:693-697. [PMID: 30474017 PMCID: PMC6236091 DOI: 10.5468/ogs.2018.61.6.693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 12/17/2022] Open
Abstract
Aggressive angiomyxoma (AA) is a very rare mesenchymal tumor most commonly found in the pelvic and perineal regions. For the complete excision of retrorectal tumors, with extension through the levator muscle into the ischioanal space, open anterior and posterior approaches are typically required. Herein, we report our experience with robotic excision of a giant presacral AA with extralevator extension into the ischioanal space and extraction via Pfannenstiel incision, which we found to be technically feasible, efficacious, and safe to perform. Mayo Clinic Institutional Review Board exemption status was obtained for this study.
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Sun C, Zou J, Wang Q, Wang Q, Han L, Batchu N, Ulain Q, Du J, Lv S, Song Q, Li Q. Review of the pathophysiology, diagnosis, and therapy of vulvar leiomyoma, a rare gynecological tumor. J Int Med Res 2017; 46:663-674. [PMID: 28875758 PMCID: PMC5971502 DOI: 10.1177/0300060517721796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The objective of this article is to discuss the pathophysiology, diagnosis, differential diagnosis, and therapy of vulvar leiomyoma. We performed a review of all English-language reports of vulvar leiomyoma published in PubMed from 1978 to 2015 using the following search terms: “vulval leiomyoma,” “vulvar leiomyoma,” “vulval smooth muscle tumor,” and “external genitalia smooth muscle tumor.” Vulvar leiomyomas, which are rare benign monoclonal tumors, most commonly occur in the fourth and fifth decades of life. The genetics of vulvar leiomyoma remain undefined. Three principal histological patterns have been identified: spindled, epithelioid, and myxoid. Imaging tests such as ultrasound, endoscopic ultrasound, and magnetic resonance imaging are used in diagnosis. Surgical excision is the only curative treatment for vulvar leiomyomas. Establishment of a full differential diagnosis list and correct final diagnosis before surgery are essential for optimal clinical management. Although recurrence of vulvar leiomyoma is extremely rare, long-term follow-up of all cases is advisable.
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Affiliation(s)
- Chao Sun
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Junkai Zou
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Qing Wang
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Qi Wang
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Lu Han
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Nasra Batchu
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Qurat Ulain
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Jiang Du
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Shulan Lv
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Qing Song
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China.,2 Center of Big Data and Bioinformatics, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China.,3 Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | - Qiling Li
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China.,2 Center of Big Data and Bioinformatics, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
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Chen H, Zhao H, Xie Y, Jin M. Clinicopathological features and differential diagnosis of aggressive angiomyxoma of the female pelvis: 5 case reports and literature review. Medicine (Baltimore) 2017; 96:e6820. [PMID: 28514296 PMCID: PMC5440133 DOI: 10.1097/md.0000000000006820] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Aggressive angiomyxoma (AAM) is a rare mesenchymal tumor that usually occurs in the pelvis and perineum of young females. AAM can simulate Bartholin's gland cyst, abscess, lipoma, simple labial cyst, or other pelvic soft tissue tumors. Here we present five cases of AAM with mean age of 42. The patients mainly presented slow-growing mass in the abdomen and perineum (3 cases in the pelvis, 1 in the vulva, and 1 in the buttock). Color Doppler flow imaging revealed blood flow for the 3 pelvic lesions. Enhanced computed tomography and magnetic resonance imaging of the other 2 cases showed the typical "swirled" or "layered" structure characteristic. Through the pathological examination, its positivity to estrogen and progesterone receptors can justify enlargement and recurrence, confirming the tumor is AAM. All 5 patients underwent local tumor resection. Two patients recurred 8 and 15 months after surgery, respectively. The longest follow-up was 42 months. Although few cases are reported, early recognition demands high index of suspicion for both gynaecologists and pathologists. Wide surgical excision with tumor free margins is the basis of curative treatment. Adjuvant therapy may be necessary for residual or recurrent tumors. Long-term follow-up is recommended.
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Affiliation(s)
| | - Hongyan Zhao
- Department of Ultrasonography, Beijing Chao-Yang Hospital (Jingxi Hospital District), Capital Medical University, Beijing, China
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A Giant Aggressive Angiomyxoma of the Pelvis Misdiagnosed as Incarcerated Femoral Hernia: A Case Report and Review of the Literature. Case Rep Surg 2016; 2016:9256749. [PMID: 27274880 PMCID: PMC4871960 DOI: 10.1155/2016/9256749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/19/2016] [Indexed: 11/18/2022] Open
Abstract
Aggressive angiomyxoma (AA) is an uncommon mesenchymal tumor that is mostly derived from the female pelvic and perineal regions. AA is a locally infiltrative slow growing tumor with a marked tendency to local recurrence. Painless swelling located around the genitofemoral region is the common symptom; thus, it is often misdiagnosed as a gynecological malignancy or a groin hernia. A 35-year-old female patient who previously underwent surgery for left femoral hernia operation resulting in surgical failure was reoperated for a giant AA located in the pelvis. The tumor was completely excised with free margins. Histopathologic examination revealed an AA. The tumor size was measured as 24 × 12 × 6 cm with a weight of 4.2 kg. Immunohistochemically, the cells show positive staining with vimentin, desmin, estrogen, and progesterone receptor. S100, MUC4, CD34, and SMA were negative in the tumor cells. AA should be considered in the differential diagnosis of any painless swelling located in the genitofemoral region, particularly in women of reproductive age. The principle treatment should be complete surgical excision with tumor-free margins. Long-term follow-up and careful monitoring are essential due to its high tendency of local recurrence in spite of wide excision of the tumor. Adjuvant antihormonal therapy yields promising results for preventing recurrence.
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