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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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Franza A, Gusmaroli E, Fabbroni C, Vigorito R, Pasquali S, Casali PG, Sanfilippo RG. Long-term disease stability with bicalutamide in a man with aggressive angiomyxoma: case report and state of art. Front Oncol 2024; 13:1260668. [PMID: 38298446 PMCID: PMC10829570 DOI: 10.3389/fonc.2023.1260668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/26/2023] [Indexed: 02/02/2024] Open
Abstract
Aggressive angiomyxoma (AA) is a rare mesenchymal neoplasm, which is commonly diagnosed in females and located in the perineal and pelvic region. Tissue specimens of AA patients often show positivity for estrogen (ER) and progesterone receptors (PgR), while some cases of androgen receptor (AR) positivity have been reported in males. When feasible, surgical excision represent the most effective treatment of AA; however, when experiencing advanced or recurrent disease, local disease control could be achieved with systemic hormonal treatment. To date, evidence regarding AA management in male patients is scarce, and only a few cases have been reported in literature. Hereby, we describe the case of a 59-year-old-man suffering from perineal AA with positivity for androgen receptors (AR) showing a long-lasting disease stability during the treatment with an AR-blocking drug (bicalutamide). A literature review regarding the state of art of AA management with a particular look to male patients is also provided.
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Affiliation(s)
- Andrea Franza
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Eleonora Gusmaroli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Fabbroni
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Raffaella Vigorito
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sandro Pasquali
- Molecular Pharmacology Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Giovanni Casali
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
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Liu XJ, Su JH, Fu QZ, Liu Y. Aggressive angiomyxoma of the epididymis: A case report. World J Clin Cases 2023; 11:7214-7220. [PMID: 37946787 PMCID: PMC10631419 DOI: 10.12998/wjcc.v11.i29.7214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Aggressive angiomyolipoma is an extremely rare benign mesenchymal tumor that was originally described as a locally recurrent mucinous spindle cell tumour. Aggressive angiomyolipoma originates from myofibroblasts, vascular smooth muscle cells, or fibroblasts, and displays various phenotypes of myofibroblasts and abnormal muscle arteries. Aggressive angiomyolipoma was first identified in 1983 and fewer than 50 male patients have been reported to date. It is an extremely rare mesenchymal tumour and often confused with other diseases. Patients with epididymal aggressive angiomyolipoma lack typical symptoms, most of which occur incidentally, although some patients may experience mild pain, discomfort, and swelling. Pain may be exacerbated by pressure from the mass. CASE SUMMARY A 66-year-old male was admitted to the hospital on January 14, 2022 with chief complaint of swelling in the left scrotum for one year. There was no apparent cause for the swelling. The patient did not consult with any doctor or receive any treatment for the swelling. The enlarged scrotum increased in size gradually until it reached approximately the size of a goose egg, and was accompanied by discomfort and swelling of the left cavity of the scrotum. The patient had no history of any testicular trauma, infection, or urinary tract infection. The patient urinated freely, 1-2 times at night, without urgency, dysuria (painful urination), or haematuria. There was no significant family history of malignancy. The patient underwent excision of the enlarged tumour and the left epididymis under general anaesthesia on January 18, 2022. Twelve months of follow-up revealed no recurrence. The patient was satisfied with the treatment. CONCLUSION Aggressive angiomyolipoma is extremely rare clinically and often confused with other diseases. The pathogenesis of aggressive angiomyolipoma is unclear and the clinical presentation is mostly a painless enlarged mass. The diagnosis of aggressive angiomyolipoma requires a combination of medical history, preoperative imaging such as computed tomography and magnetic resonance imaging, cytological examination and preoperative and postoperative pathological biopsy. The preferred treatment is surgery, with the possibility of a new alternative treatment option after hormonal therapy. Aggressive angiomyolipoma should be considered in the differential diagnosis of parametrial tumors of the male genital area that present as clinically significant masses. The high recurrence rate of aggressive angiomyolipoma may be related to incomplete tumor resection, and patients with aggressive angiomyolipoma are advised to undergo annual postoperative follow-up and imaging for recurrence.
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Affiliation(s)
- Xu-Jie Liu
- Department of Urology Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning Province, China
| | - Jia-Hao Su
- Department of Urology Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning Province, China
| | - Qi-Zhong Fu
- Department of Urology Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning Province, China
| | - Ying Liu
- Department of Urology Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning Province, China
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Collins K, Warmke LM, Chen S, Ulbright TM. Angiomyofibroblastoma and Potential Mimicking Soft Tissue Tumors That May Occasionally Present in the Retroperitoneum: An Approach to the Differential Diagnosis With Report of an Unusual Index Case Abutting the Kidney. Adv Anat Pathol 2022; 29:141-153. [PMID: 35275847 DOI: 10.1097/pap.0000000000000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The retroperitoneal soft tissues, extending from the pelvic floor to the level of the diaphragm, are the source of a variety of mesenchymal neoplasms with overlapping features and distinct clinical behaviors, making their distinction of crucial importance. Herein, we report a rare retroperitoneal angiomyofibroblastoma (AMFB) that presented as a right abdominal mass in a 25-year-old woman and that clinically simulated a primary renal carcinoma. The patient underwent complete surgical resection showing a well-circumscribed tumor adjacent to but separate from the right kidney. It was comprised of irregular, often anastomosing islands and cords of plump to spindled cells in a collagenous stroma with numerous thin-walled vessels. The tumor cells clustered around the vessels and admixed with moderate numbers of adipocytes. There was neither significant nuclear atypia nor mitotic activity. Immunohistochemically, the tumor cells showed strong reactivity for desmin, diffuse expression of estrogen and progesterone receptors, retained nuclear expression of retinoblastoma protein, and absent CD34 expression. The immunomorphological features were these of a "lipomatous variant" of AMFB of the retroperitoneum. The occurrence of AMFB in the retroperitoneum is unexpected since it mostly develops in the lower genital tract of young women, making its recognition in this rare location difficult. As a consequence, more common pelvic or retroperitoneal soft tissue neoplasms may represent the primary diagnostic considerations. We, therefore, review a variety of soft tissue tumors occurring in the pelvis/retroperitoneum that, to some degree, may mimic AMFB, and present key findings to assist in accurate diagnosis.
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Affiliation(s)
- Katrina Collins
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN
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Sun J, Lian PH, Ye ZX, Dong DX, Ji ZG, Wen J, Li HZ. Aggressive Angiomyxoma in the Scrotum: A Case Series and Literature Review. Front Surg 2022; 9:762212. [PMID: 35310439 PMCID: PMC8924411 DOI: 10.3389/fsurg.2022.762212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeAggressive angiomyxoma (AAM) was identified as a distinct clinicopathological entity in 1983. Since then, a few cases of its occurrence in the scrotum have been reported. This case series was performed to increase clinicians' understanding of the clinical features and treatment of AAM in the scrotum.MethodsWe evaluated the clinical presentations, treatments, and follow-up of two patients with AAM in the scrotum in our hospital and 34 cases reported in the literature.ResultsAmong the 36 patients, the average age was 48.3 ± 20.6 years old (range from 1 to 81); the average maximum diameter of the tumor was 8.36 cm (1.6–25 cm); the site of one (2.78%) patient was located in the epididymis, two (5.56%) in the testes, five (13.89%) in the spermatic cord, and 28 (77.77%) in the scrotum. The clinical symptoms were generally non-specific and 20 patients inadvertently discovered their slow-growing painless masses. The treatments for all these patients were surgical excision once the tumor had been found and one case underwent excision followed by radiotherapy. The median follow-up time for the remaining 32 cases was 24.5 months (1 to 84 months). Recurrence occurred in three cases (9.09%) at the primary sites and no cases of distant metastasis.ConclusionAAM of the scrotum can occur in middle-aged and elderly men. The clinical manifestation generally involves a long history of asymptomatic masses or swelling in the scrotum. Ultrasound is the most commonly used diagnostic technique but magnetic resonance imaging may be more effective. The mainly treatment is surgical excision and postoperative histopathological examination is still the gold standard for its diagnosis. Although it is locally aggressive, metastasis is extremely rare in males.
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Affiliation(s)
- Juan Sun
- Division of General Surgery, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Peng H. Lian
- Division of Urology, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zi X. Ye
- Division of Urology, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - De X. Dong
- Division of Urology, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhi G. Ji
- Division of Urology, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jin Wen
- Division of Urology, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Jin Wen
| | - Han Z. Li
- Division of Urology, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Han Z. Li
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Magro G, Angelico G, Michal M, Broggi G, Zannoni GF, Covello R, Marletta S, Salvatorelli L, Parenti R. The Wide Morphological Spectrum of Deep (Aggressive) Angiomyxoma of the Vulvo-Vaginal Region: A Clinicopathologic Study of 36 Cases, including Recurrent Tumors. Diagnostics (Basel) 2021; 11:diagnostics11081360. [PMID: 34441295 PMCID: PMC8394817 DOI: 10.3390/diagnostics11081360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Deep angiomyxoma (DAM) is currently included in the category of “specific stromal tumors of the lower female genital tract”, along with angiomyofibroblastoma, cellular angiofibroma and myofibroblastoma. Given the high rate of local recurrences, it is crucial to recognize DAM from other tumors that possess indolent behaviour. In the present paper, we analyzed the morphological and immunohistochemical features of 42 surgically-resected vulvo-vaginal DAMs (36 primary and 6 recurrent lesions) in order to widen the morphological spectrum of this uncommon tumor. Methods: A series of 36 cases of surgically-resected primary vulvo-vaginal DAMs were retrospectively collected. Locally recurrent tumors were also available for six of these cases. Results: Out of the primary tumors, 25 out of 36 exhibited the classic-type morphology of DAM. In the remaining cases (11/36 cases), the following uncommon features, which sometimes coexist with one another, were observed: (i) alternating myxoid and collagenized/fibrous areas; (ii) hypercellular areas; (iii) neurofibroma-like appearance; (iv) perivascular hyalinization; (v) microcystic/reticular stromal changes; (vi) “microvascular growth pattern”; (vii) perivascular cuffing; (viii) nodular leiomyomatous differentiation; (ix) hypocellular and fibro-sclerotic stroma. Among the six locally recurrent tumors the following features were observed: (i) classic-type morphology; (ii) hypocellular fibro-sclerotic stroma; (iii) extensive perivascular hyalinization, lumen obliteration and formation of confluent nodular sclerotic masses; (iv) hypercellularity. Immunohistochemically, the neoplastic cells of classic-type DAM in both primary and recurrent tumors were diffusely stained with desmin, suggesting a myofibroblastic nature; in contrast, the neoplastic cells showing elongated fibroblastic-like morphology and set in collagenized/fibrosclerotic stroma in both primary and recurrent tumors were negative or only focally stained with desmin, which is consistent with a fibroblastic profile. Conclusion: Although diagnosis of DAM is usually straightforward if typical morphology is encountered, diagnostic problems may arise when a pathologist is dealing with unusual morphological features, especially hypercellularity, extensive collagenous/fibrosclerotic stroma or neurofibroma-like appearance.
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Affiliation(s)
- Gaetano Magro
- Department of Medical and Surgical Sciences and Advanced Technologies, “G. F. Ingrassia”, Anatomic Pathology, University of Catania, 95123 Catania, Italy; (G.B.); (L.S.)
- Correspondence: ; Tel.: +39-095-378-2023
| | - Giuseppe Angelico
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Gineco-Patologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Michal Michal
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, 30166 Plzen, Czech Republic;
- Bioptical Laboratory, Ltd., 30166 Plzen, Czech Republic
| | - Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies, “G. F. Ingrassia”, Anatomic Pathology, University of Catania, 95123 Catania, Italy; (G.B.); (L.S.)
| | - Gian Franco Zannoni
- Unit of Gyneco-Pathology and Breast Pathology, Department of Women’s Health, Childhood and Public Health Sciences, A. Gemelli IRCCS University Hospital Foundation, Institute of Pathological Anatomy, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Renato Covello
- Pathology Department, Regina Elena National Cancer Institute IRCCS, 00168 Rome, Italy;
| | - Stefano Marletta
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, 37010 Verona, Italy;
| | - Lucia Salvatorelli
- Department of Medical and Surgical Sciences and Advanced Technologies, “G. F. Ingrassia”, Anatomic Pathology, University of Catania, 95123 Catania, Italy; (G.B.); (L.S.)
| | - Rosalba Parenti
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Physiology, University of Catania, 95123 Catania, Italy;
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Altinmakas E, Dogan H, Temur M, Guneyli S. Incidentally detected perineal aggressive angiomyxoma in an asymptomatic patient with uterine leiomyomas. J OBSTET GYNAECOL 2021; 41:1178-1179. [PMID: 33632039 DOI: 10.1080/01443615.2020.1849070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Emre Altinmakas
- Department of Radiology, Koc University School of Medicine, Istanbul, Turkey
| | - Hakan Dogan
- Department of Radiology, Koc University School of Medicine, Istanbul, Turkey
| | - Muzaffer Temur
- Department of Obstetrics and Gynecology, Private Doruk Hospital, Bursa, Turkey
| | - Serkan Guneyli
- Department of Radiology, Koc University School of Medicine, Istanbul, Turkey
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Chapel DB, Cipriani NA, Bennett JA. Mesenchymal lesions of the vulva. Semin Diagn Pathol 2020; 38:85-98. [PMID: 32958293 DOI: 10.1053/j.semdp.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 02/01/2023]
Abstract
Mesenchymal lesions of the vulva include site-specific entities limited to the lower genital tract, as well as a range of non-site-specific tumors that are more common at extragenital sites. Site-specific lesions include fibroepithelial stromal polyp, cellular angiofibroma, angiomyofibroblastoma, and aggressive angiomyxoma. Non-site-specific tumors that may occur in the vulva include those of smooth muscle, skeletal muscle, vascular, neural, adipocytic, and uncertain differentiation. This review discusses both site-specific and non-site-specific vulvar mesenchymal lesions including non-neoplastic proliferations, benign neoplasms, locally aggressive neoplasms with a predilection for local recurrence, neoplasms of indeterminate biologic potential, and frankly malignant neoplasms with a high risk of distant metastasis and death. Accurate diagnosis is essential for proper management, and is facilitated by correlation with clinical findings and targeted application of immunohistochemical and molecular studies.
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Affiliation(s)
- David B Chapel
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Nicole A Cipriani
- Department of Pathology, The University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA
| | - Jennifer A Bennett
- Department of Pathology, The University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA.
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Retrospective analysis of clinicopathological features and prognosis for aggressive angiomyxoma of 27 cases in a tertiary center: a 14-year survey and related literature review. Arch Gynecol Obstet 2020; 302:219-229. [PMID: 32430760 DOI: 10.1007/s00404-020-05592-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/06/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Aggressive angiomyxoma (AAM) is a rare and often misdiagnosed tumor that is characterized by frequent local recurrences. This study aimed to investigate the clinicopathological characteristics, surgical experiences, and prognosis for aggressive angiomyxoma to improve the accuracy of diagnosis and develop treatment strategies for decreasing recurrence rates. METHODS Clinicopathological data and follow-up information for 27 patients with AAM diagnosed and treated at the Shengjing Hospital of China Medical University between January 2006 and October 2019 were retrospectively analyzed. RESULTS The median age at disease onset among 27 patients was 39 years. The male to female ratio was 1:4.4. Painless and slow-growing mass was the most common symptom. Masses occurring in the perineum and pelvic cavity accounted for 81.5% (22/27). All of the 27 patients underwent surgical treatment. Surgical approaches included transperineal and transvaginal resection. Large pelvic masses were treated with combined abdominoperineal surgery. The postoperative recurrence rate was 37%. Kaplan-Meier survival analysis revealed that 5-year progression-free survival (PFS) rate was 64.4% and the median PFS was 132.0 ± 29.6 (95% CI 72.9-190.1). Multivariate Cox proportional analysis found that surgical margin is an independent prognostic factor for PFS (P = 0.018). None of the patients experienced distant metastasis. CONCLUSIONS Clinical manifestations of AAM are non-specific. Laboratory testing, imaging examinations, and immunohistochemistry are helpful for diagnosis and differential diagnosis. Surgical approach can be determined according to the relationship between the tumor and adjacent organs and infiltration degree. The development of personalized treatment strategies should aim to achieve a complete resection on the premise of preserving the structure and function of important organs to maintain patient quality of life.
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Tyagi S, Mavuduru RS, Bora GS, Devana SK, Sharma AP. Prominent swelling on erection: Perineal angiomyxoma as a rare entity. INDIAN JOURNAL OF UROLOGY : IJU : JOURNAL OF THE UROLOGICAL SOCIETY OF INDIA 2019; 35:81-82. [PMID: 30692730 PMCID: PMC6334575 DOI: 10.4103/iju.iju_221_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Perineal angiomyxoma is a rare entity, more commonly seen in females. We report a case of a 44 year old male who presented with a perineal swelling which became prominent with penile erections. Magnetic Resonance Imaging (MRI) revealed a T1 hypointense and T2 hyperintense midline lesion (4.6 × 2.5 × 5 cm) in relation to corpus spongiosum, with ill defined fat planes with the bulbospongiosus muscle and progressive enhancement on dynamic contrast sequence. A differential diagnosis of soft tissue sarcoma or hemangioma was made and the mass was completely excised via a midline perineal incision. The histopathology revealed features consistent with angiomyxoma.
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Affiliation(s)
- Shantanu Tyagi
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Girdhar S Bora
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudheer Kumar Devana
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya Prakash Sharma
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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11
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Fibroepithelial Stromal Polyp of the Vulva: Case Report and Review of Potential Histologic Mimickers. Int J Gynecol Pathol 2018; 37:e1-e5. [PMID: 28863069 DOI: 10.1097/pgp.0000000000000437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Vulvar tumors arising from submucosal connective tissue, some of which exhibit hormonal responsiveness, have many clinical and histologic overlapping characteristics. We present a case of a fibroepithelial stromal polyp arising from the vulva of a 22-year-old female. We review the differential diagnosis with an emphasis on distinguishing features of these uncommon neoplasms. Accurate diagnosis is essential as the extent of surgical resection and risk of local recurrence varies for these tumors.
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12
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Aggressive Angiomyxoma-Report of a Rare Male Buttock Lesion. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1879. [PMID: 30324062 PMCID: PMC6181506 DOI: 10.1097/gox.0000000000001879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/06/2018] [Indexed: 11/26/2022]
Abstract
Aggressive angiomyxoma is a very rare benign tumor for male population with fewer than 50 cases reported since the description of this tumor. Most documented cases of aggressive angiomyxomas were found in genital, perineal, and pelvic regions in women of child bearing age. We report a case of a massive (> 20 cm) aggressive angiomyxomas in a man who presented with perineal swellings. Macroscopically the mass was highly vascular and lobulated with high similarity to plexiform neurofibroma. Microscopic examination revealed a hypocellular tumor comprising bland oval and spindle-shaped cells along with vessels of varying calibre. The accompanying stroma was myxocollagenous. Immunohistochemical staining showed CD34 and focal estrogen receptors positivity and negative staining for S100, actin, desmin, and progesterone receptors. The histologic and immunohistochemical features favored the diagnosis of aggressive angiomyxoma. Despite the rarity of such tumor in the male population, aggressive angiomyxoma should be considered in the differential diagnosis when encountering chronic para-perineal lesions.
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Criteria for Risk Stratification of Vulvar and Vaginal Smooth Muscle Tumors: An Evaluation of 71 Cases Comparing Proposed Classification Systems. Am J Surg Pathol 2017; 42:84-94. [PMID: 28786880 DOI: 10.1097/pas.0000000000000920] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Accurate risk stratification of smooth muscle tumors (SMTs) is essential for appropriate patient management. Yet, the rarity of SMTs of the vagina and vulva makes development of a prognostically meaningful classification system challenging. While 2 classification methods for vulvar SMTs and 1 for vaginal SMTs have been proposed, it is our experience that many pathologists tend to apply criteria for uterine SMTs when evaluating vulvovaginal tumors. We retrospectively reviewed a large cohort of vulvovaginal SMTs with clinical follow-up and evaluated which method most accurately classified tumors according to patient outcome. A total of 71 tumors, 53 vaginal (75%) and 18 vulvar (25%), from 71 patients were identified. All tumors were centrally examined for degree of cytologic atypia, morphology (spindled, epithelioid, myxoid), mitotic index per 10 high power fields, atypical mitotic figures, tumor cell necrosis, ischemic necrosis, tumor interface (circumscribed or infiltrative) and margin status. Clinical features were recorded for each patient. Follow-up was available for 63 patients (89%), and ranged from 1 to 234 months (median: 64 mo). While site-specific and uterine criteria showed equally excellent sensitivity in classifying smooth muscle neoplasms as leiomyosarcoma according to patient outcome, uterine criteria showed improved specificity relatively to site-specific methods in classifying tumors as nonsarcoma according to patient outcome. We recommend that uterine SMT criteria and nomenclature be adopted for evaluation and classification of vulvovaginal SMTs.
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Umranikar S, Ubee S, Williams G. Aggressive angiomyxoma of the perineum: a rare presentation in a male with 4 years follow up. J Surg Case Rep 2017; 2017:rjx086. [PMID: 28928916 PMCID: PMC5597893 DOI: 10.1093/jscr/rjx086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 08/03/2017] [Indexed: 11/23/2022] Open
Abstract
Angiomyxoma are rare myxoid cells tumours that occur predominantly in women in the fourth decade. They are classified as the less aggressive superficial and the deeper aggressive variety commonly called aggressive angimyxomas. We report a rare perineal aggressive angiomyxoma in a 79-year-old male presenting with a painless perineo-scrotal mass. Radiological investigations confirmed a lobulated well-defined mass separate from the testicles and histology following wide local excision confirmed aggressive angiomyxoma. He remains recurrence free at 4 years of surveillance which is the among longest reported follow-up for perineal angiomyxoma.
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Affiliation(s)
- Salil Umranikar
- Department of Urology, Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury SY3 8XQ,UK
| | - Sarvpreet Ubee
- Department of Urology, New Cross Hospital, Wolverhampton Road, Wolverhampton WV10 0QP,UK
| | - Graham Williams
- Department of General Surgery, New Cross Hospital, Wolverhampton Road, Wolverhampton WV10 0QP, UK
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15
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Aydin AM, Katipoglu K, Baydar DE, Bilen CY. Long-standing aggressive angiomyxoma as a paratesticular mass: A case report and review of literature. SAGE Open Med Case Rep 2017; 5:2050313X17712090. [PMID: 28616233 PMCID: PMC5459349 DOI: 10.1177/2050313x17712090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/02/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives: Aggressive angiomyxoma is known as a mesenchymal tumor of premenopausal women and it is extremely rare in men. Methods: Herein, we report a 66-year-old male with a firm scrotal mass that had gradually enlarged over 20 years. Results: Radiological studies revealed 10 x 15 cm mass lesion confined to right scrotum with neither local invasion nor distant metastasis. Inguinal orchiectomy was performed and histopathology showed characteristic features of an aggressive angiomyxoma occupying paratesticular region, which was a challenging diagnosis due to its unexpected occurrence in the male gender. Conclusion: Aggressive angiomyxoma is mostly considered as a benign tumor in females despite its propensity for local recurrence. Whether it may show a divergent biological behavior in men is unknown as the reported cases are too few.
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Affiliation(s)
- Ahmet M Aydin
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kubra Katipoglu
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Dilek E Baydar
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Cenk Y Bilen
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Intravenous leiomyomatosis: an unusual intermediate between benign and malignant uterine smooth muscle tumors. Mod Pathol 2016; 29:500-10. [PMID: 26892441 PMCID: PMC5891726 DOI: 10.1038/modpathol.2016.36] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 01/09/2016] [Accepted: 01/10/2016] [Indexed: 12/29/2022]
Abstract
Intravenous leiomyomatosis is an unusual smooth muscle neoplasm with quasi-malignant intravascular growth but a histologically banal appearance. Herein, we report expression and molecular cytogenetic analyses of a series of 12 intravenous leiomyomatosis cases to better understand the pathogenesis of intravenous leiomyomatosis. All cases were analyzed for the expression of HMGA2, MDM2, and CDK4 proteins by immunohistochemistry based on our previous finding of der(14)t(12;14)(q14.3;q24) in intravenous leiomyomatosis. Seven of 12 (58%) intravenous leiomyomatosis cases expressed HMGA2, and none expressed MDM2 or CDK4. Colocalization of hybridization signals for probes from the HMGA2 locus (12q14.3) and from 14q24 by interphase fluorescence in situ hybridization (FISH) was detected in a mean of 89.2% of nuclei in HMGA2-positive cases by immunohistochemistry, but in only 12.4% of nuclei in negative cases, indicating an association of HMGA2 expression and this chromosomal rearrangement (P=8.24 × 10(-10)). Four HMGA2-positive cases had greater than two HMGA2 hybridization signals per cell. No cases showed loss of a hybridization signal by interphase FISH for the frequently deleted region of 7q22 in uterine leiomyomata. One intravenous leiomyomatosis case analyzed by array comparative genomic hybridization revealed complex copy number variations. Finally, expression profiling was performed on three intravenous leiomyomatosis cases. Interestingly, hierarchical cluster analysis of the expression profiles revealed segregation of the intravenous leiomyomatosis cases with leiomyosarcoma rather than with myometrium, uterine leiomyoma of the usual histological type, or plexiform leiomyoma. These findings suggest that intravenous leiomyomatosis cases share some molecular cytogenetic characteristics with uterine leiomyoma, and expression profiles similar to that of leiomyosarcoma cases, further supporting their intermediate, quasi-malignant behavior.
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17
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Schoolmeester JK, Fritchie KJ. Genital soft tissue tumors. J Cutan Pathol 2015; 42:441-51. [PMID: 25925211 DOI: 10.1111/cup.12507] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/01/2015] [Accepted: 04/04/2015] [Indexed: 01/12/2023]
Abstract
Mesenchymal neoplasms of the vulvovaginal and inguinoscrotal regions are among the most diagnostically challenging specimens in the pathology laboratory owing largely to their unique intersection between general soft tissue tumors and relatively genital-specific mesenchymal tumors. Genital stromal tumors are a unique subset of soft tissue tumors encountered at this location, and this group includes fibroepithelial stromal polyp, superficial (cervicovaginal) myofibroblastoma, cellular angiofibroma, mammary-type myofibroblastoma, angiomyofibroblastoma and aggressive angiomyxoma. Aside from the striking morphologic and immunophenotypic similarity that is seen with these entities, there is evidence that a subset of genital stromal tumors may be linked genetically. This review will focus on simplifying this group of tumors and provide the pathologist or dermatopathologist with practical management information. Smooth muscle tumors of the external genitalia will also be discussed.
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Affiliation(s)
- John K Schoolmeester
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.,Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Karen J Fritchie
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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18
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Aggressive angiomyxoma of the vulva: a bizarre perineal lesion. Case Rep Oncol Med 2015; 2015:292304. [PMID: 25977826 PMCID: PMC4421102 DOI: 10.1155/2015/292304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 04/15/2015] [Indexed: 12/27/2022] Open
Abstract
Introduction. Aggressive angiomyxoma is a rare, slowly growing, and benign tumour of mesenchymal origin, which affects women of reproductive age and is associated with a high risk of local recurrence. Case Presentation. A case of a 47-year-old white female is presented herein, with a large polypoid, gelatinous mass on the right labia majora, measuring 26 × 21 × 6 cm. Histopathologically, the lesion was composed of spindle and stellate-shaped cells embedded in a myxoid matrix. Another specific feature was the presence of variable-sized thin-walled capillaries and thick-walled vascular channels. The patient underwent wide local excision of the tumour with clear margins and developed local recurrence 18 months later. Discussion. Aggressive angiomyxoma of the vulva needs to be distinguished from benign myxoid tumors with a low risk of local recurrence as well as from malignant myxoid neoplasms. Usually wide local excision with tumour-free margins and occasionally hormonal manipulation is the treatment of choice.
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Yaman H, Erdem H, Belada A, Besir FH, Oktay M, Uzunlar AK. Life-threatening angiomyxoma of the larynx. Ethiop J Health Sci 2015; 25:105-7. [PMID: 25733791 PMCID: PMC4337075 DOI: 10.4314/ejhs.v25i1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Angiomyxoma is a benign proliferative mesenchymal tumor and a very rare mass in the larynx. There is not enough information about the etiology, clinical finding, treatment and prognosis of laryngeal angiomyxoma. Case Details A 52 years old man presented with respiratory distress. Also, he had suffered from dysphagia, dysphonia, cough, and obstructive sleep apnea in the supine position for 6 months. He was operated on via transoral approach under general anesthesia with orotracheal intubation. The mass was encapsulated and completely removed. The histopathologic diagnosis was reported as angiomyxoma. Conclusion Angiomyxoma should be considered in the differential diagnosis of the larynx masses. The treatment of angiomyxomas of the larynx is surgical. The mass can be usually excised intraorally or endoscopically.
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Affiliation(s)
- Huseyin Yaman
- Department of Otorhinolaryngology, Duzce Medical Faculty, Duzce University, Turkey
| | - Havva Erdem
- Department of Pathology, Duzce Medical Faculty, Duzce University, Turkey
| | - Abdullah Belada
- Department of Otorhinolaryngology, Duzce Medical Faculty, Duzce University, Turkey
| | - Fahri Halit Besir
- Department of Radiology, Duzce Medical Faculty, Duzce University, Turkey
| | - Murat Oktay
- Department of Pathology, Duzce Medical Faculty, Duzce University, Turkey
| | - Ali Kemal Uzunlar
- Department of Pathology, Duzce Medical Faculty, Duzce University, Turkey
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20
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Aggressive angiomyxomas: a comprehensive imaging review with clinical and histopathologic correlation. AJR Am J Roentgenol 2014; 202:1171-8. [PMID: 24848813 DOI: 10.2214/ajr.13.11668] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
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Abstract
Myxoid tumors are a heterogeneous group of lesions characterized by a marked abundance of extra cellular mucoid (myxoid) matrix.[1] The term aggressive emphasizes the often infiltrative nature of the tumor and its frequent association with recurrence.[2] A case of aggressive angiomyxoma arising from the vagina in a 55-year-old woman is reported for its rarity.
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Affiliation(s)
- L Padmavathy
- Urban Health Center, Division of Community Medicine, RMMC, Annamalai University, Annamalai Nagar, Chidambaram, Tamil Nadu, India
| | - L Lakshmana Rao
- Division of Pathology, RMMC, Annamalai University, Annamalai Nagar, Chidambaram, Tamil Nadu, India
| | - M Dhana Lakshmi
- Division of Pathology, RMMC, Annamalai University, Annamalai Nagar, Chidambaram, Tamil Nadu, India
| | - N Sylvester
- Division of Pathology, RMMC, Annamalai University, Annamalai Nagar, Chidambaram, Tamil Nadu, India
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Karwacki GM, Stöckli M, Kettelhack C, Mengiardi B, Studler U. Radiographic diagnosis and differentiation of an aggressive angiomyxoma in a male patient. J Radiol Case Rep 2014; 7:1-6. [PMID: 24421942 DOI: 10.3941/jrcr.v7i7.1154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aggressive angiomyxoma is a rare soft-tissue tumor which usually occurs in female patients of reproductive age. Its occurrence in men is even more unusual and as illustrated in this case the difference between pathology suggested by a physical examination and its actual extent can be quite striking. We present a case report of an 81-year-old man with the typical MRI appearances of a pelvic aggressive angiomyxoma, describe imaging and histopathologic features of this rarely seen locally infiltrative neoplasm and also discuss therapeutic options for patients with an aggressive angiomyxoma.
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Affiliation(s)
- Grzegorz Marek Karwacki
- Department of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - Martin Stöckli
- Institute of Pathology, University of Basel Hospital, Basel, Switzerland
| | | | | | - Ueli Studler
- Department of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
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23
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Gupta M, Prateek S, Arora R. Angiomyxoma – A rare case report. APOLLO MEDICINE 2013. [DOI: 10.1016/j.apme.2013.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Abstract
Myxomas of the hand are rare tumours and the diameters are usually smaller than 2 cm. In this report we describe the biggest reported myxoma that localised on the dorsal hand and the comprehensively review of hand myxomas. This case is to our knowledge the first hormone-receptor-positive myxoma of the hand.
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Affiliation(s)
- Serdar Nasır
- Department of Plastic and Reconstructive Surgery, Süleyman Demirel University School of Medicine, Isparta, Turkey.
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25
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26
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Aggressive Angiomyoma of the Female Genital Tract and Pelvis—Clinicopathologic Features With Immunohistochemical Analysis. Int J Gynecol Pathol 2011; 30:505-13. [DOI: 10.1097/pgp.0b013e318211d56c] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Abstract
Aggressive angiomyxoma (AA) is an uncommon tumor occurring in females and is rarely reported in males with propensity to recur. Due to its presence in perineal and genital region, it has to be differentiated from other myxoid neoplasms. The tumor expresses estrogen and progesterone receptors, which may have a role to play in tumor therapy. Wide local excision remains the mainstay of the treatment. We present a case of AA excised from left spermatic cord.
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Affiliation(s)
- Ajay Malik
- Department of Pathology, Armed Forces Medical College, Pune-411 040, India
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29
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Sawada Y, Ito F, Nakazawa H, Tsushima N, Tomoe H, Aiba M. A rare benign genitourinary tumor in a Japanese male: urinary retention owing to aggressive angiomyxoma of the prostate. Rare Tumors 2010; 2:e15. [PMID: 21139944 PMCID: PMC2994486 DOI: 10.4081/rt.2010.e15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 02/19/2010] [Indexed: 02/04/2023] Open
Abstract
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.
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30
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Aggressive angiomyxoma of larynx: case report and literature review. The Journal of Laryngology & Otology 2009; 124:793-5. [DOI: 10.1017/s0022215109992350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:We report the second known case of aggressive angiomyxoma of the larynx.Method:Case report and a review of the world literature concerning angiomyxoma of the larynx and recent advances in the immunohistochemical, cytogenic and clinical study of its female pelvic counterpart.Results:Aggressive angiomyxoma is a rare mesenchymal tumour originally thought only to occur in the female pelvis and peritoneum, or rarely in the male genital tract. A 47-year-old man presented with a one-month history of dysphonia. He was found to have a supraglottic mass on endoscopic examination, and underwent a laryngofissure approach excision biopsy and covering tracheostomy. Histological analysis showed a characteristic proliferation of spindle cells widely separated by loose, myxoid stroma with a prominent vascular component. Aggressive angiomyxoma was diagnosed.Conclusion:To our knowledge, this is the second report in the world literature of aggressive angiomyxoma of the larynx. Comparison with the female pelvic counterpart facilitates diagnosis, aided by recent advances, and suggests that complete surgical excision with a wide margin is the treatment of choice.
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Abstract
A variety of site-specific mesenchymal lesions of the lower genital tract may occur, which are often diagnostically challenging because of their morphologic overlap. Some of this morphologic homogeneity presumably stems from a potentially shared origin from the specialized superficial stroma of the distal female genital tract. Despite shared appearances, morphologic distinction remains the gold standard for diagnosis of most of these lesions, as immunoperoxidase staining is often not helpful in their distinction.
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Affiliation(s)
- Marisa R Nucci
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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32
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Wallace SM, Szabo KA, Schlabritz-Loutsevitch NE, Dick EJ, Blanchard TW, Hubbard GB. Myxomatous neoplasms in the perineal region of baboons. J Med Primatol 2008; 37:261-70. [PMID: 19017193 DOI: 10.1111/j.1600-0684.2008.00293.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In baboons, Papio sp. neoplasms tend to affect the hematopoietic system most commonly, with rare documentation of myxomatous neoplasms. In contrast, women can develop myxomatous masses within deep peripelvic tissues with some frequency during their reproductive years. METHODS We have identified and examined, retrospectively, myxomatous perineal masses in twelve female baboons within one research facility and compared their histopathologic, immunohistochemical and electron microscopic features to their human variants. RESULTS Our results indicate that these myxomatous neoplasms, in humans and non-human primates, share common features. CONCLUSION Further research, particularly molecular genetic analysis, may be needed to identify the baboon as a true animal model for myxomatous perineal neoplasms.
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Affiliation(s)
- Shannon M Wallace
- Department of Pathology, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
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Dierickx I, Deraedt K, Poppe W, Verguts J. Aggressive angiomyxoma of the vulva: a case report and review of literature. Arch Gynecol Obstet 2008; 277:483-7. [PMID: 18214507 DOI: 10.1007/s00404-008-0561-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Accepted: 01/03/2008] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Inge Dierickx
- Department of Obstetrics and Gynaecology, Katholieke Universiteit Leuven, Leuven, Belgium
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Kumar S, Agrawal N, Khanna R, Khanna A. Aggressive angiomyxoma presenting with huge abdominal lump: A case report. CASES JOURNAL 2008; 1:131. [PMID: 18755035 PMCID: PMC2535586 DOI: 10.1186/1757-1626-1-131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 08/28/2008] [Indexed: 11/10/2022]
Abstract
Agressive angiomyxoma is a rare mesenchymal neoplasm. It mainly presents in females. We here present a case of angiomyxoma presenting as huge abdominal lump along with gluteal swelling. Case note is described along with brief review of literature.
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Affiliation(s)
- Sanjeev Kumar
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, India.
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35
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Camps Lasa J, Navarro Luna A, Muñoz Duyos A, García Domingo MI, Marco Molina C. [Aggressive pelvic-perineal angiomyxoma in males]. Cir Esp 2008; 84:102-3. [PMID: 18682191 DOI: 10.1016/s0009-739x(08)72144-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Judith Camps Lasa
- Unidad de Coloproctología. Servicio de Cirugía General y Digestiva. Hospital Mútua de Terrassa. Terrassa. Barcelona. España.
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36
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Pai CY, Nieh S, Lee JC, Lo CP, Lee HS. Aggressive angiomyxoma of supraclavicular fossa: A case report. Head Neck 2008; 30:821-4. [DOI: 10.1002/hed.20747] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Heim-Hall J, Yohe SL. Application of immunohistochemistry to soft tissue neoplasms. Arch Pathol Lab Med 2008; 132:476-89. [PMID: 18318588 DOI: 10.5858/2008-132-476-aoitst] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2007] [Indexed: 11/06/2022]
Abstract
CONTEXT Soft tissue tumors are composed of numerous and complex diagnostic entities. Because of this complexity and the recognition of an intermediate malignancy category including some tumors with a deceptively bland histologic appearance, soft tissue tumors may represent a major diagnostic challenge to the general practicing pathologist. OBJECTIVE To correctly diagnose soft tissue tumors with the ancillary use of immunohistochemistry. DATA SOURCES Review of the current literature with emphasis on those tumors for which immunohistochemistry has proven to be particularly useful. CONCLUSIONS Immunohistochemistry plays an important role in the diagnosis of soft tissue tumors. One of its major utilities is to correctly identify a tumor as being of mesenchymal or nonmesenchymal origin. Once mesenchymal origin has been established, histologic subtyping according to specific cell lineage may be achieved with the use of lineage-specific markers. Tumors of uncertain cell lineage and tumors with primitive small round cell morphology are often characterized by a unique immunohistochemical phenotype. In this group of tumors, immunohistochemistry is most widely applied and is of greatest value. Despite the rapid development of molecular genetic techniques, immunohistochemistry still remains the most important diagnostic tool in the diagnosis of soft tissue tumors aside from recognition of morphologic features and clinical correlation.
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Affiliation(s)
- Josefine Heim-Hall
- Department of Pathology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, Mail Code #7750, San Antonio, TX 78229-3900, USA.
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Hidayat AA, Flint A, Marentette L, Torczynski E, Al-Qahtani JM, Ahl NC, Elner VM. Myxomas and Angiomyxomas of the Orbit. Ophthalmology 2007; 114:1012-9. [PMID: 17467533 DOI: 10.1016/j.ophtha.2006.12.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Revised: 12/20/2006] [Accepted: 12/21/2006] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To report clinical and histopathologic features and biologic behavior of orbital myxomas and angiomyxomas. DESIGN Noncomparative retrospective case series. PARTICIPANTS Patients with histopathologic diagnoses of orbital myxoma or angiomyxoma. METHODS Clinical metadata and features were obtained from the medical record. Neoplasms were studied by routine histopathology, special stains, and immunohistochemistry. MAIN OUTCOME MEASURES Final diagnosis, based on histopathology, special stains, and immunohistochemistry, and clinical course from analysis of metadata and clinical features. RESULTS Three myxomas and 3 angiomyxomas were identified in 5 males and 1 female. Median age at presentation was 56 years (range, 4-69), with a follow-up ranging from 6 months to 8 years. Two angiomyxomas occurred in children ages 4 and 7 years whose tumors were locally aggressive and recurred. Recurrence also complicated one case of myxoma after incomplete excision. Pathologically, the tumors were poorly circumscribed. Histopathology showed them to be hypocellular, containing stellate and spindled cells in an abundant, loose, myxoid stroma rich in hyaluronic acid. Small blood vessels were rare in myxomas but abundant in angiomyxomas. Tumor cells were frequently immunoreactive for vimentin, CD34, and factor XIIIa. CONCLUSIONS Myxomas rarely involve orbital tissue, and no angiomyxomas of the region have been previously reported. Angiomyxomas in children may be aggressive. Vascularity and bone involvement appear to be important prognostic features for recurrence. Complete resection with a margin of healthy tissue appears to be the treatment of choice. Tumor cell immunopositivity for vimentin, CD34, and factor XIIIa may assist in the histopathologic diagnosis.
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Affiliation(s)
- Ahmed A Hidayat
- Department of Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC, USA
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Dove S, Remoué P, Valo I, Ybarlucea LR, Panel N, Fondrinier E. Unusual female pelvic tumour: aggressive angiomyxoma. Eur J Obstet Gynecol Reprod Biol 2007; 137:123-5. [PMID: 17267097 DOI: 10.1016/j.ejogrb.2006.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2006] [Revised: 10/23/2006] [Accepted: 11/13/2006] [Indexed: 11/24/2022]
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Mourra N, Hoeffel C, Gaujoux S, Coindre JM, Flejou JF. Myxoid perineal tumour in a 25-year-old woman. Histopathology 2006; 49:533-6. [PMID: 17064300 DOI: 10.1111/j.1365-2559.2006.02526.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- N Mourra
- Department of Pathology, Hôpital Saint-Antoine, AP-HP, Paris, France
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Idrees MT, Hoch BL, Wang BY, Unger PD. Aggressive angiomyxoma of male genital region. Report of 4 cases with immunohistochemical evaluation including hormone receptor status. Ann Diagn Pathol 2006; 10:197-204. [PMID: 16844560 DOI: 10.1016/j.anndiagpath.2005.09.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aggressive angiomyxoma (AA), first described by Steeper and Rosai (Am J SurgPathol. 1983;7:463-475), is a rare locally infiltrative tumor that usually arises in the pelvic and perineal soft tissues of young women. Approximately 150 cases have been reported in women. Aggressive angiomyxoma has a high rate of local recurrence because of its infiltrative growth and anatomical location making complete excision with wide margins difficult. To our knowledge, 39 cases of AA occurring in men have been reported in the literature. Sites frequently involved include the scrotum, spermatic cord, inguinal region, and perineum. The gross and microscopic appearances and clinical course are similar to those described in female cases. Immunohistochemistry evaluating estrogen and progesterone receptors (ER and PR, respectively), although frequently positive in the female cases, has rarely been studied in the male cases. We report the clinicopathologic features of 4 additional cases of AA in men with particular emphasis on hormone (ER/PR) receptor status. Hormone reactivity is significant in that AA may arise from specialized hormonally responsive stromal cells of the perineum and may potentially play a therapeutic role in unresectable tumors. From our small series, hormone positivity (1 case of ER+, 3 cases of PR+) does occur in the male cases of AA, and a large number of cases should be examined to determine the frequency at which these tumors express hormone receptors.
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Affiliation(s)
- Mohammed T Idrees
- Department of Pathology, The Lilian and Henry M. Stratton-Hans Popper, Mount Sinai Medical Center, New York, NY 10029, USA
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Alobaid A, Goffin F, Lussier C, Drouin P. Aggressive Angiomyxoma of the Vulva or Perineum: Report of Three Patients. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2005; 27:1023-6. [PMID: 16529669 DOI: 10.1016/s1701-2163(16)30501-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Aggressive angiomyxoma is a rare, locally aggressive soft tissue tumour that chiefly involves the vulvoperineal region of young female patients. Treatment is wide surgical excision. Frequent relapses are common. CASES We present three patients who each had an aggressive angiomyxoma treated initially for another presumed diagnosis. Two patients required immediate repeat surgical procedures for incomplete tumour excision. The third patient developed a recurrence two years after the initial surgery. In one patient, hormonal therapy was used postoperatively because the evaluation of the tumour margins was uncertain. Harpoon markers were used to aid in tumour localization in another patient prior to resection. CONCLUSION Clinicians should consider the diagnosis of aggressive angiomyxoma when a patient presents with an atypical vulvoperineal mass, as an incorrect diagnosis may lead to repeated surgical procedures.
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Affiliation(s)
- Abdulaziz Alobaid
- Department of Gynecology Oncology, Notre-Dame Hospital, CHUM, University of Montreal, Montreal, QC
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