A RARE CASE OF ANGIOMYXOMA OF THE VULVA – A CASE REPORT
2Department of Gynecology, Obstetrics and Reproductive Medicine, Sarajevo School of Science and Technology, Sarajevo
3Department of Internal Diseases, Cantonal Hospital Zenica, Zenica
Problem statement
Angiomyxoma is a rare, locally invasive, slow-growing mesenchymal tumor occurring usually in women of reproductive age. The tumor is known for multiple local recurrences with a low potential to metastasize. About 350 cases have been documented in the literature so far.
Methods
We present case of 59-year old woman, para 1 with a swelling on her right labium major for 5 years who presented to the Department of Gynecology and Obstetrics in Cantonal Hospital Zenica due to the acute bleeding from the tumor.
Results
A 59-year old postmenopausal woman came to the Hospital with acute bleeding from the tumor on her right labium major which was slowly growing for 5 years. Past medical and family history was unremarkable. On general examination, the patient was moderately built and afebrile without anemia, cyanosis, lymphadenopathy, weight loss or any bowel and bladder dysfunction. Local examination showed a well-circumscribed pedunculated polypoidal non-tender, soft and spongy mass measuring 18x15cm with exulcerated area of 3x2cm. A local excision in local anesthesia was performed immediately without complications and bleeding and the specimen was sent to pathological evaluation. The pathology and immunohistochemistry report showed that the tumor was composed of spindle and stellate-shapped cells in a myxoid matrix. Some of the cells had pseudoinclusions, the tumor was rich in blood vessels and had no mitotic figures. The tumor was positive for estrogen receptors and negative for AE1/AE3, S-100, CD34, SMA, desmin, myogenin and progesterone receptors. These findings were suggestive of deep angyomyxoma of the vulva which was partly exulcerated.
Conclusion
Angiomyxoma is a rare, locally aggressive neoplasm. It is usually seen among women of reproductive age. However, this case report confirms that, although very uncommon, it can also be seen among postmenopausal women. It can be easily misdiagnosed with other vulvar diseases such as Bartholini’s cyst, lipoma, Gartner duct cyst, or sarcoma. It is mandatory to keep in mind angioyxoma when an asymptomatic and slow-growing vulvar mass is detected in women, especially in the reproductive age. Due to the local recurrences, timely diagnosis and management with surgical excision and adjuvant therapy are beneficial for such patients.
