Angiomyofibroblastoma of the vagina in a postmenopausal breast cancer patient treated with tamoxifen: clinicopathologic analysis of a case and review of the literature

Abstract

Angiomyofibroblastoma is a rare mesenchymal tumor. This study presents the clinical, histologic, and immunohistochemical features of an angiomyofibroblastoma of the vagina occurring in an 80-year-old breast cancer patient under prolonged treatment with tamoxifen. Histologically, the tumor was characterized by alternating hypercellular and hypocellular edematous zones and small- to medium-sized blood vessels, which were characteristically thin walled. The tumor cells were spindle shaped (mainly) or round shaped (occasionally) arranged in cords and nests. The stroma was edematous and contained inflammatory cells, especially lymphocytes and mast cells. Immunohistochemistry of the tumor cells revealed diffuse and intense immunoreactivity for vimentin and desmin. The staining for estrogen receptors and progesterone receptors was positive, with a percentage of 70% and 40%, respectively. In conclusion, the tumor was diagnosed as an angiomyofibroblastoma based on its typical histologic and immunohistochemical features. The expression of estrogen and progesterone receptors suggests that it might arise as a neoplastic proliferation of hormonally responsible mesenchymal cells. Tamoxifen may exert stimuli effects upon mesenchymal cells.

Angiomyofibroblastoma of the Vulva

“…The Jung-Won Seo, et al Angiomyofibroblastoma of the vulva tumor cells also show variable expression for muscle actin and are positive for estrogen and/or progesterone receptors [5]. Because of this hormonal receptor expression, the tumor suggests that it might arise from hormonally responsible mesenchymal cells [3]. The patient underwent simple excision with clear margin of the lesion.…”

“…AMFB occurs primarily in the vulvo-vaginal area of middle-aged women [1][2][3]. The histologic findings of the tumors are abundant thin-walled blood vessels with hypocellular and hypercellular areas [4].…”

Angiomyofibroblastoma of the uterine cervix in a breast cancer patient: A case report

“…The incidence of uterine mesenchymal neoplasm can also be increased by tamoxifen therapy [9]. A case of angiomyofi broblastoma related to tamoxifen treatment in a breast cancer patient was fi rst reported by Varras et al [10] The author assumed that tamoxifen may exert hormonal stimuli upon mesenchymal cells, resulting in the development of AMFB. Lee et al [11] presented a case of AMFB of vagina in a toremifene, a synthetic analogue of estrogen receptors, treated breast cancer patient.…”

Possible Relationship Between Tamoxifen Therapy and Vaginal Angiomyofibroblastoma

“…1 The tumor predominantly arises in vulva while vaginal location is extremely rare and only 11 cases have been reported so far in the English literature. [2][3][4][5][6][7][8][9][10][11] We identified another case who had a history of infiltrative ductal carcinoma of breast and had undergone a left modified radical mastectomy 2 years ago followed by radiotherapy and combined chemotherapy consisting of cyclophosphamide and adriamycine. She was 37 years old during her admittance for routine gynaecologic examination when she was on tamoxifen therapy and monthly goserelin injections for 18 months.…”

“…10,[12][13][14] In an attempt to clarify the indeterminate etiopathogenesis of this rare entity, some of the recently published articles suggested a possible relation between development of angiomyofibroblastoma and use of selective est-rogen receptor modulators (SERMs). 3,7 Tamoxifen is the prototype of SERMs. It has clear anti-estrogenic effects on the breast and therefore is used orally for breast cancer treatment.…”