Aggressive angiomyxoma of the vagina: Case report and review of the literature

OBJECTIVE

To present the case of a patient diagnosed with aggressive angiomyxoma of the vagina and to conduct a review of the diagnosis, treatment and prognosis of this disease condition.

METHODS

A 46-year old female patient complaining of dysuria and vaginal mass sensation. Physical exploration and imaging studies revealed a tumor extending into the pelvic cavity. The mass was resected through a vaginal approach and pathology of the surgical specimen showed an aggressive angiomyxoma of the vagina. New retrorectar surgery was performed three months after the initial resection because of recurrence. A search was conducted in the Medline via PubMed, Lilacs, Scielo and Google Scholar databases using the terms "Angiomyxoma," "Aggressive" and "Vagina." The search included review articles, case reports and case series published in English and Spanish since 1995. The information extracted included diagnosis, symptoms, signs, immunohistochemistry and imaging studies used, type of treatment surgical or other - and prognosis. Findings are described in narrative form.

RESULTS

Overall, 23 titles were identified, of which 14 case reports, 2 clinical case series and 1 review article met the inclusion criteria. Sixty-five per cent of the patients were between 30 and 50 years of age. Diagnosis was made by immunohistochemistry in 8 cases, and diagnostic imaging was used in 12 cases. Computed tomography showed sharper contours of the lesions. Surgical treatment was applied in all reports, supplemented by hormonal therapy in 4 cases. There was follow-up in 14 of the 17 cases reported.

CONCLUSIONS

Aggressive angiomyxoma of the vagina is rare. Assessment of the role of various immunohistochemical tests is needed in cases identified as aggressive angiomyxoma on histopathology. Evaluation of hormonal treatment as an adjunct to surgery is required. Prognosis is good.

Post-chikungunya chronic inflammatory rheumatism: Follow-up of cases after 1 year of infection in Tolima, Colombia

INTRODUCTION

Chronic Inflammatory Rheumatism (CIR) is one of the recognized and increasingly reported consequence post-chikungunya infection (pCHIK) in Colombia and Latin America.

METHODS

Retrospective cohort study of 128 patients with CHIK that persisted with pCHIK-CIR after 59-68 weeks (1.13-1.31 years). This information was evaluated by means of a telephone survey and according to validated criteria (WHO 2015) previously (patients with >12 weeks post-CHIK with ≥1 manifestations [continuous/recurrent]: chronic polyarthralgia [pCHIK-CPA], stiffness and/or joint edema).

RESULTS

Of the total CHIK-infected subjects finally included (n = 65), 28 (43.1%) reported pCHIK-CPA; and 38 patients (58.5%) at least one persistent rheumatological symptoms over the last year (pCHIK-CIR); 38.5% of them, morning stiffness, 18.5% joint edema, and 3.1% joint redness. No significant sex differences were found; 60% of patients with pCHIK-CPA aged> 40 years (RR = 3.75; 95%CI 1.47-9.53). The 29.2% of patients required medical attention because of symptoms.

CONCLUSIONS

Nearly half of patients with CHIK had at least one rheumatologic symptom persistent over a year, and the third of them, pCHIK-CPA. These results are comparable with previous estimates obtained in other cohorts in the country (Risaralda and Sucre) and are consistent with results from other studies in France and India.