An Unusual Case of Scrotal Aggressive Angiomyxoma (AAM) Masquerading as Non-Reducible Inguinal Hernia – A Rare Case Report and Literature Review

Abstract

This case report details a rare instance of scrotal Aggressive Angiomyxoma (AAM) in a 62-year-old male, presenting with a gradually enlarging mass masquerading as a non-reducible inguinal hernia. AAM, predominantly found in adult females, is an exceptionally uncommon occurrence in men. The diagnostic challenge lay in the rarity of male cases and the tumor’s mimicry of common conditions like inguinal hernia. Upon physical examination, a non-reducible, non-tender swelling extending from the right inguinal region to the scrotal sac was noted. Radiological investigations initially suggested a scrotal mass or non-reducible inguinal hernia. Intraoperative exploration revealed a large encapsulated cystic mass, measuring 12 x 8 cm, originating from the inguinal ligament. Histopathological examination confirmed the diagnosis of aggressive angiomyxoma, characterized by spindle-shaped tumor cells, thick-walled blood vessels, and myxoid texture. The discussion underscores the diagnostic complexities of AAM, emphasizing the necessity of histopathological examination for conclusive diagnosis. A review of male AAM cases in the literature highlights similarities with female cases, supporting the expression of estrogen (ER) and progesterone receptors (PR). Surgical removal with clear margins is the primary treatment, although recurrence rates vary. The potential role of hormonal therapy, especially in ER and PR positive cases, is noted but requires further exploration. In conclusion, this rare case sheds light on the clinical and pathological characteristics of scrotal AAM in men. The diagnostic journey underscores the importance of considering AAM in the differential diagnosis of scrotal masses. Long-term follow-up is crucial due to the tumor’s propensity for local recurrence, making this case a valuable addition to the limited literature on male AAM.