Aggressive angiomyxoma

Authors

  • T. Ramani Devi Department of Obstetrics and Gynecology, Ramakrishna Medical Centre LLP and Janani Fertility Centre, Trichy, Tamil Nadu, India
  • D. Sangavi Department of Obstetrics and Gynecology, Ramakrishna Medical Centre LLP and Janani Fertility Centre, Trichy, Tamil Nadu, India
  • A. Deepika Department of Obstetrics and Gynecology, Ramakrishna Medical Centre LLP and Janani Fertility Centre, Trichy, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20213874

Keywords:

Angiomyxoma, Bartholin’s cyst, Reproductive age, Wide excision, Follow-up for recurrence

Abstract

Angiomyxoma is a rare slow-growing, benign low-grade tumor occurring in women of reproductive age group which is known for its recurrence. The symptoms are variable. Mrs. K. aged 33 years, reached our outpatient department (OPD) with complaints of painless swelling on the right labial region which she was feeling uncomfortable while sitting. Mass was found to be mobile with no evidence of inflammatory change. The location of the mass made us think about, Bartholin’s cyst and hence surgical excision of the mass was done. The whole mass was found to be lying below the fat in the right labial region and wide excision was completed. The histopathology of the mass was reported as angiomyxoma. Angiomyxoma arises from the mesenchymal tissue and it is locally invasive with high recurrence rate. It is more common in females. Mostly seen in the vulvovaginal, pelvic cavity and perineum. The lesion can reach huge size. It has to be differentiated from gynecologic malignancies, cyst, abscess and hernia. Histology along with immune-histochemistry can confirm the lesion. Wide excision is the mode of treatment. Incomplete excision can lead to relapse. Relapse can happen in 35-72% of the cases. Local recurrence may occur between 2 months to 15 years following initial diagnosis. Hence, follow up is essential. Angiomyxoma is a very rare condition and only around 250 cases have been reported in the world literature. It has to be differentiated from other benign conditions. Diagnosed by non-invasive techniques like ultrasound sonography (USG), magnetic resonance imaging (MRI) and computed tomography (CT). Wide excision is the treatment of choice. Long term follow up is needed as recurrences are high.

Author Biography

T. Ramani Devi, Department of Obstetrics and Gynecology, Ramakrishna Medical Centre LLP and Janani Fertility Centre, Trichy, Tamil Nadu, India

Gynaeclogy

References

Huang CC, Sheu CY, Chen TY, Yang YC. Aggressive angiomyxoma: A small palpable vulvar lesion with a huge mass in the pelvis. J Low Genit Tract Dis. 2013;17(1):75-8.

Sutton BJ, Laudadio J. Aggressive angiomyxoma. Arch Pathol Lab Med. 2012;136(2):217-21.

Steeper TA, Rosai J. Aggressive angiomyxoma of the female pelvis and perineum. Report of nine cases of a distinctive type of gynecologic soft-tissue neoplasm. Am J Surg Pathol. 1983;7:463-75.

Rashmi B, Anish K, Vanita S, Raje N. Aggressive Angiomyxoma of the Vulva in Pregnancy: A Case Report and Review of Management Options. Med Gen Med. 2007;9(1):16.

Dahiya K, Jain S, Duhan N, Nanda S, Kundu P. Aggressive angiomyxoma of vulva and vagina: a series of three cases and review of literature. Arch Gynecol Obstetr. 2011;283(5):1145-8.

Bai HM, Yang JX, Huang HF, Cao DY, Chen J, Yang N et al. Individualized managing strategies of aggressive angiomyxoma of female genital tract and pelvis. Eur J Surg Oncol. 2013;39(10):1101-8.

Siassi RM, Papadopoulos T, Matzel KE. Metastasizing aggressive angiomyxoma. N Engl J Med. 19992;341(23):1772.

Sato K, Ohira M, Shimizu S, Kuroda S, Ide K, Ishiyama K et al. Aggressive angiomyxoma of the liver: A case report and literature review. Surg Case Rep. 2017;3(1):92.

Salman MC, Kuzey GM, Dogan NU, Yuce K. Aggressive angiomyxoma of vulva recurring 8 years after initial diagnosis. Arch Gynecol Obstetr. 2009;280(3):485-7.

Minagawa T, Matsushita K, Shimada R. Aggressive angiomyxoma mimicking inguinal hernia in a man. Int J Clin Oncol. 2009;14(4):365-8.

Salman MC, Kuzey GM, Dogan NU, Yuce K. Aggressive angiomyxoma of vulva recurring 8 years after initial diagnosis. Arch Gynecol Obstet. 2009;280:485-7.

Methieson A, Chandrakanth S, Yousef G. Aggressive angiomyxoma of the pelvis: A case report. Can J Surg. 2007;50:228-9.

Chihara Y, Fujimoto K, Takada S, Hirayama A, Cho M. Aggressive angiomyxoma in the scrotum expressing androgen and progesterone receptors. Int J Urol. 2003;10:672-5.

Morag R, Fridman E, Mor Y. Aggressive angiomyxoma of the scrotum mimicking huge hydrocele: case report and literature review. Case rep Med. 2009;2009:157624.

Choi H, Park C, Ji Y. Alternative surgical approaches for aggressive angiomyxoma at different sites in the pelvic cavity. Obstetr Gynecol Sci. 2015;58(6):525-9.

Nakamura T, Miura K, Maruo Y. Aggressive angiomyxoma of the perineum originating from the rectal wall. J Gastroenterol. 2002;37(4):303-8.

Qi S, Li B, Peng J. Aggressive angiomyxoma of the liver: a case report. Int J Clin Exp Med. 2015;8(9):15862-5.

Bai HM, Yang JX, Huang HF, Cao DY, Chen J. Individual managing strategies of aggressive angiomyxoma of female genital tract and pelvis. Eur Oncol. 2013;39(10):1101-8.

Surabhi VR, Garg N, Frumovitz M, Bhosale P, Prasad SR, Meis JM. Aggressive angiomyxomas: a comprehensive imaging review with clinical and histopathologic correlation. Am J Roentgenol. 2002;202(6):1171-8.

Van Roggen JFG, Van Unnik JAM, Briaire-De Bruijn IH, Hogendoorn PCW. Aggressive angiomyxoma: a clinicopathological and immunohistochemical study of 11 cases with long-term follow-up. Virchows Archiv. 2005;446(2):157-63.

Varras M, Akrivis C, Lekkou P, Kitsiou E, Demou A. Aggressive angiomyxoma of the vulva: our experience of a rare case with review of the literature. Eur J Gynaecol Oncol. 2006;7(2):188-92.

Nucci MR, Fletcher CDM. Vulvovaginal soft tissue tumours: update and review. Histopathology. 2000;36(2):97-108.

McCluggage WG, Connolly L, McBride HA. HMGA2 is a sensitive but not specific immunohistochemical marker of vulvovaginal aggressive angiomyxoma. Am J Surg Pathol. 2006;34(7):1037-42.

Rabban JT, Dal Cin P, Oliva E. HMGA2 rearrangement in a case of vulvar aggressive angiomyxoma. Int J Gynecol Pathol. 2006;25(4):403-7.

Lee MY, Da Silva B, Ramirez DC, Maki RG. Novel HMGA2-YAP1 fusion gene in aggressive angiomyxoma. BMJ Case Rep. 2019;28;12:5.

Poirier M, Fraser R, Meterissian S. Case 1 Aggressive angiomyxoma of the pelvis: response to luteinizing hormone releasing hormone agonist. J Clin Oncol. 2003;21:3535-6.

Ma J, Wan J, Jiang B. Huge abdominal and perineal aggressive angiomyxoma: A misdiagnosed case report and literature review. Cell Mol Biol. 2008;64:110-11.

Chan YM, Hon E, Ngai SW, Ng TY, Wong LC. Aggressive angiomyxoma in females: Is radical resection the only option? Acta Obstet Gynecol Scand. 2000;79:216‑20.

Han‑Geurts IJ, Van Geel AN, Van Doorn L, Den Bakker M, Eggermont AM, Verhoef C. Aggressive angiomyxoma: Multimodality treatments can avoid mutilating surgery. Eur J Surg Oncol. 2006;32:1217‑21.

Tariq R, Hasnain S, Tariq Siddiqui M, Ahmed R. Aggressive angiomyxoma: swirled configuration on ultrasound and MR imaging. J Pak Med Asso. 2014;64(3):345-8.

Huang CC, Sheu CY, Chen TY, Yang YC. Aggressive angiomyxoma: A small palpable vulvar lesion with a huge mass in the pelvis. J Low Genit Tract Dis. 2013;17(1):75-8.

Downloads

Published

2021-09-27

Issue

Section

Case Reports