Abstract
Aggressive angiomyxoma (AA), a rare mesenchymal tumor with high recurrence rate and infiltrative nature, most generally arises in the vulvovaginal region, perineum, and pelvis of women in reproductive age peaking from age 31 to 35 but uncommonly found on men. It appears as a slow-growing gelatinous mass, which commonly asymptomatic. Imaging studies including USG, CT scan, and MR imaging are of great importance for the diagnosis of AA on identifying the mass characteristics. This paper reports a case of a 37 year old P3A0 woman with a lump on the left side of vaginal lip for 2 weeks before admission. The lump was soft to touch and was not painful, without other accompanying symptoms. Past medical history showed the lump has recurred after being surgically removed. On physical examination, a lump was found on the left vulva with soft consistency. CT scan showed a well-circumscribed hypodense mass on left labia majora and showed post contrast wall enhancement. Fine needle aspiration biopsy was done and showed hypocellular smear with myxoid matrix and bleeding. The mass was then removed by vulvectomy procedure. Histopathological analysis of the mass shows infiltration of myxoid stroma with blood vessels consistent with aggressive angiomyxoma. In conclusion, AA is usually asymptomatic and has high tendency of recurrence. Imaging procedure is useful on identifying mass characteristics and biopsy can be done to establish AA diagnosis. Surgery is the main modality for the treatment of AA, and administration of gonadotropin-releasing hormone analogue can prevent further recurrence.Keywords: Aggressive angiomyxoma, gonadotropin-releasing hormone agonist, recurrent
Highlights
Aggressive angiomyxoma is a rare tumor of vulvovaginal and perineal region
We report a case of aggressive angiomyxoma with multiple prior recurrences with history of complicated surgery by a general surgeon, and resolved by gynecologist oncologist's surgical intervention
We reported a case of a 37 year old female with lump on the left side of her vaginal lip for 2 weeks before admission
Summary
The tendency to infiltrate adjacent organs emphasize its aggressiveness, it is classified as benign tumor since it has no metastasize capability [1] The incidence of this disease peaks on the third decade of life and most commonly occurred on female [2,3]. This disease has very high recurrence rate after being surgically removed [4] and is accompanied with scarce symptoms occurrence [4], every patient with recurrent painless nodule in perineal and vulvovaginal region has to pay more attention towards this disease. We report a case of aggressive angiomyxoma with multiple prior recurrences with history of complicated surgery by a general surgeon, and resolved by gynecologist oncologist's surgical intervention. This case represents a most typical appearance of aggressive angiomyxoma considering its recurrence and asymptomatic nature, and the significance of gynecologist intervention, especially oncologist gynecologist, on management of this patient
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