Aggressive angiomayxoma in men: Case report and systematic review

Prostatic aggressive angiomyxoma (AAM) with initial presentation of urinary obstruction: a rare case report and literature review

Background

Aggressive angiomyxoma (AAM) is a rare benign mesenchymal tumor known for its aggressive behavior and high recurrence rates, with male cases of AAM being less frequently reported. This study presents a rare case of primary prostatic AAM characterized by a prostatic urethral mass obstructing the bladder outlet, resulting in acute renal dysfunction.

Case Description

The 51-year-old male patient presented with lumbar pain, nausea, frequent urination, urgency, and incomplete urination. Laboratory test indicated increased levels of serum creatinine and potassium. Emergency bedside ultrasound found giant bilateral hydronephrosis. The patient received emergent potassium-lowering therapy and bilateral nephrostomy. Computed tomography (CT) revealed a 3.7 cm × 2.3 cm low-density soft tissue mass in prostate. Transurethral resection of the prostatic mass was performed. Pathological examination identified the presence of deep-seated AAM. For fear of recurrence, he underwent radical prostatectomy. Postoperative histopathology showed no sign of residual tumor. He recovered uneventfully and is now under regular follow-up.

Conclusions

AAM is a rarely reported locally aggressive mesenchymal neoplasm characterized by high recurrence, which was even rarer in prostate. As we know, this is the first case of prostatic AAM treated by both transurethral resection and further radical resection. In this case, the tumor was completely excised surgically, but long-term follow-up is required to monitor for recurrence.

An Unusual Cause of Inguinal Mass in a Patient with Urolithiasis: A Case Report of Deep (Aggressive) Angiomyxoma in a Male Patient

Background: Deep or aggressive angiomyxoma is an uncommon neoplasm of the pelvis. Although deep angiomyxoma is a benign tumor, its tendency to infiltrate soft tissues and reach a large size (typically > 10 cm) indicates aggressive biological behavior. It is usually present in female patients, but there have been recent reports of male-aggressive angiomyxoma. While rare, it is an important consideration in patients with a pelvic mass. The clinical presentation is non-specific; patients are either asymptomatic or present with non-specific complaints, such as dull pain, constipation, and dysuria. It is commonly mistaken for an inguinal hernia, hydrocele, testicular cancer, lipoma, and epididymal cyst in male patients, thus misguiding the management of these cases. Hence, preoperative evaluation with imaging studies (ultrasound, computed tomography, magnetic resonance imaging) and biopsy allows for an accurate diagnosis and treatment. Currently, the standard of treatment is surgical resection of the tumor with free margins. The role of hormone therapy is under investigation for patients with deep angiomyxoma positive for estrogen/progesterone receptors. Regular follow-up is necessary given the high recurrence rate of deep angiomyxoma (9-72%). Methods: We present a case of an elderly man who presented with hematuria due to urolithiasis and an asymptomatic inguinal mass mimicking an inguinal hernia. A computed scan (CT) of the abdomen confirmed the presence of the mass, which was removed surgically. Results: The pathologic examination of the tumor was consistent with deep angiomyxoma. Conclusions: The diagnosis of deep angiomyxoma should always be considered in patients with an inguinal mass to avoid delayed treatment and incomplete surgical excision.

Long-term disease stability with bicalutamide in a man with aggressive angiomyxoma: case report and state of art

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.

Characteristics and outcomes of patients with primary abdominopelvic aggressive angiomyxoma: a retrospective review of 12 consecutive cases from a sarcoma referral center

BACKGROUND

Aggressive angiomyxoma (AAM) is a rare mesenchymal tumor that mostly arises from the pelvic and perineal soft tissues. Few studies reported its characteristics and outcomes previously due to its rarity and challenges of treatments. This study aimed to investigate the clinical characteristics as well as surgical and short-term survival outcomes of primary abdominopelvic AAM.

METHODS

Medical records of patients who were admitted to surgery with pathological confirmation of primary abdominopelvic AAM at Peking University International Hospital from January 2016 through December 2021 were retrospectively retrieved from our retroperitoneal tumor database. Demographics, operative outcomes and pathological findings were collected. Patients received followed-up routinely after the surgery. Survival probabilities were calculated and determined through Kaplan-Meier analysis.

RESULTS

A total of 12 consecutive patients (male/female 4:8) were included in this study. The median age was 45 years old. The clinical presentation varied among individuals, consisting of 2 abdominal discomforts, 4 constipations, 1 lumbago, 1 prolonged menstruation, and 1 buttock swelling. R0/R1 resection was achieved in 100% of patients. Postoperatively, 50% of patients developed various complications including 3 fistulas and 3 wound infections. No operative mortality was observed. Histopathology of all patients was suggestive of AAM. Immunohistochemistry was done with a 91.7% positive rate for estrogen and progesterone receptors. The median recurrence-free survival time was 38 months. There were no cases of deceased or presented with distal metastasis during a median of 42 months' follow-up.

CONCLUSIONS

The clinical manifestations of abdominopelvic AAM are mostly atypical. Surgical resection with curative intents remains the mainstay treatment of this disease, which was strongly suggested in experienced sarcoma centers due to the high probability of severe postoperative complications. In addition, long-term follow-up is necessary due to the high rate of local recurrences.