Aggressive Angiomyxoma with Diffusion-Weighted Magnetic Resonance Imaging and Dynamic Contrast Enhancement: A Case Report and Review of the Literature

Abstract

Introduction: Aggressive angiomyxoma (AA) is a rare benign soft tissue tumour usually affecting the pelvis and perineum of young women. Magnetic resonance imaging (MRI) is crucial in the management of AA patients for its diagnostic contribution and for the preoperative assessment of the actual tumour extension. Given the current development of less aggressive therapeutics associated with a higher risk of recurrence, close follow-up with MRI is fundamental after treatment. In this context, diffusion-weighted (DW) imaging has already shown high efficacy in the detection of early small relapses in prostate or rectal cancer. Case Report: We report here a case of pelvic AA in a 51-year-old woman examined with dynamic contrast enhancement and DW-MRI, including apparent diffusion coefficient mapping and calculation. Conclusions: To our knowledge, this is the first description of DW-MRI in AA reported in the literature. Here, knowledge about imaging features of AA will be reviewed and expanded.

Aggressive angiomyxoma of the pelvis with inferior vena cava involvement: MR imaging features

“…Brunelle et al described a case of an aggressive pelvic angiomyxoma in a 51-year-old female patient in whom a multi-modal examination was performed. The tumor was hyperintense on DWI images at b0 and b1000 with a high ADC of 2 × 10-3 mm 2 /sec, similar to what is found in myxoid tumors [10]. The dynamic enhancement examination of this tumor after gadolinium showed gradual enhancement with no plateau or washout, suggesting that it was fibrous in nature.…”

Aggressive Angiomyxoma: Two Case Reports and Review of the Literature

“…Owing to the ability to provide valuable qualitative and quantitative features of the tumor, DWI has been a hot topic in oncology. There are some articles reported the DWI of AA showed a high value of tumor ADC measurement more than 2 × 10 -3 mm 2 /sec [7,8] as in our second case. The S Brunelle, et al observed DWI showed heterogeneous high signal intensity both on b0 and b1000 images [8].…”

“…There are some articles reported the DWI of AA showed a high value of tumor ADC measurement more than 2 × 10 -3 mm 2 /sec [7,8] as in our second case. The S Brunelle, et al observed DWI showed heterogeneous high signal intensity both on b0 and b1000 images [8]. However in our second case, we only observed high signal intensity on b0 images.…”

“…The most characteristic feature of the tumor is the laminated or swirled pattern on T2WI and enhanced T1WI mainly because of the inherent vascularity in the stroma [3,8]. On DCE MRI, the tumor presents a progressive enhancement without a plateau or washout.…”

Aggressive Angiomyxoma: Two Case Reports and Review of the Literature

“…The surgery of wide local excision is the mainly option in the measurements [7,8]. The rate of local recurrence of AA is different from reports but shows a decrease pattern in recent years.…”