Angiofibroma of the Vagina Presenting with Abnormal Vaginal Bleeding: A Case Report from Ethiopia and Review of the Literature

Abstract

Background. Angiofibroma is an uncommon type of vascular benign tumor that is made up of blood vessels and fibrous (connective) tissue. First described in 1997, it usually occurs in middle aged females and is clinically often thought to represent a cyst. Unlike most of the other site specific vulvovaginal mesenchymal lesions, cellular angiofibroma has a marked predilection for the vulva with only occasional examples reported in the vagina. Case Detail. A 17-year adolescent nulligravid girl presented with a history of irregular vaginal bleeding of two-year duration and history of lower abdominal swelling; on examination, she had pale conjunctiva, 20-week sized firm, irregular, nontender abdominopelvic mass, and a firm huge anterior vaginal wall mass, with difficulty to reach at the cervix and hemoglobin of 9.7 gm/dL, and a diagnosis of cervical myoma plus anemia was made, which was supported by imaging studies. Finally it was found to be angiofibroma of the vagina. Conclusion. Angiofibromas are benign tumors, which rarely occur in vagina. Although middle aged females are affected more, angiofibromas can affect females of reproductive age group and can cause abnormal uterine bleeding.

Cervicovaginal cellular angiofibroma

“… 1 3 5 7 8 10 11 In female patients, CA most frequently arises in middle-aged women, although over the last few years, multiple case reports have described cases of angiofibromas occurring in women of different age groups. 2 12 …”

“…The most common site for CA is the vulvovaginal region (particularly the labium majorum and vulva) and therefore, it is usually preoperatively diagnosed as a Bartholin cyst. 2 5 Cases with only vaginal involvement or even extragenital locations have been described. 11 …”

“…The number of mitotic figures can vary from few to many. 2 4–8 10 11 13 Immunohistochemistry on CA is not very specific. About 55% of these tumours express CD34 on immunohistochemistry, whereas only 20%–25% express smooth muscle actin and 8% express desmin.…”

“…Complete local excision appears to be adequate and effective in preventing recurrence and morbidity to surrounding tissues. 2–5 7 11 …”

“…Cellular angiofibroma (CA) is a rare benign soft tissue tumour that can be found in both male and female patients but mostly affects middle-aged women. [1][2][3][4] It is most commonly found in the distal genital region and is generally well circumscribed and small sized. 3 The differential diagnosis should include other (malignant) tumours and a distinction is made based on histopathological and immunohistochemical characteristics.…”