Recurrent Aggressive Angiomyxoma
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.
Author: Imam Rasjidi M,
Christine Susanto, Ryan Putra Wondany
Journal Code: jpkedokterangg160144