Angiomyofibroblastoma of the vulva diagnosed preoperatively: A case report

Abstract

Abstract.A 50-year-old woman (gravida 2, para 2) first noticed a small nodule in the right labium majus 2 years prior to the initial visit to the Hachinohe Red Cross Hospital (Hachinohe, Japan), which had gradually increased in size. On physical examination, a well-circumscribed, elastic, firm, goose egg-sized, subcutaneous mass protruding from the right labium majus was identified. On magnetic resonance imaging (MRI), the lesion was hypointense on T1-weighted images and was well-circumscribed, strongly enhanced and homogeneous on gadolinium-enhanced images, measuring 7.5x4 cm. The same tumor had measured 2.6 cm on an MRI performed 6 years earlier. Based on the clinical course and imaging findings, angiomyofibroblastoma was diagnosed and surgical resection of the tumor was performed. The tumor was well-circumscribed and highly vascular. The intraoperative blood loss was 70 ml. Histopathologically, the tumor cells were concentrated around blood vessels, were spindle-shaped to oval with mild atypia, and were positive for vimentin, desmin, neural cell adhesion molecule (N-CAM), CD-34, estrogen receptor and progesterone receptor, and negative for S-100. Based on these findings, the diagnosis of angiomyofibroblastoma was confirmed. Angiomyofibroblastoma is a benign mesenchymal tumor that occurs in the female external genitalia. Differentiation of this tumor from aggressive angiomyxoma, a fast-growing infiltrative malignancy that occurs in the same region, may be challenging. The diagnosis of angiomyofibroblastoma is usually based on the histopathological findings of the resected specimen. The present case is of value, as the angiomyofibroblastoma was successfully diagnosed preoperatively based on the clinical course and imaging findings.

Vaginal Angiomyofibroblastoma: A Case Report and Review of Diagnostic Imaging

“…Median age was 45, and the majority of cases were observed in women less than 60 years of age [ 8 ]. Since 2015, there have been 10 additional cases including ours describing AMFB in females, six of which were located in the vulva, one cervical, one in the broad ligament, and one on the patient's foot [ 2 , 9 – 17 ]. All women were under the age of 50.…”

“…On MRI, AMFB is typically well circumscribed [ 9 ]. It is rare to see central necrosis or degeneration but it does not rule out AMFB [ 9 ].…”

“…On MRI, AMFB is typically well circumscribed [ 9 ]. It is rare to see central necrosis or degeneration but it does not rule out AMFB [ 9 ]. AMFB is most often described as hypointense on T1 weighted (T1W) images, similar to that of skeletal muscle, hyperintense on T2 weighted (T2W) images, and with homogenous hyperenhancement on gadolinium chelate (Gd-C) enhanced images [ 1 , 9 , 23 , 28 ].…”

“…It is rare to see central necrosis or degeneration but it does not rule out AMFB [ 9 ]. AMFB is most often described as hypointense on T1 weighted (T1W) images, similar to that of skeletal muscle, hyperintense on T2 weighted (T2W) images, and with homogenous hyperenhancement on gadolinium chelate (Gd-C) enhanced images [ 1 , 9 , 23 , 28 ]. Differences in T1W and T2W signal intensity may be attributable to variations in lipid and collagenous content in AMFB [ 8 , 23 , 28 – 31 ].…”

Laparoscopic removal of a vaginal leiomyoma using bladder suspension technique

“…Key words: vaginal leiomyoma, bladder suspension technique, laparoscopic surgery 膀胱吊り上げ法を使用し、腹腔鏡下に摘出しえた腟平滑筋腫の1例 亀田総合病院 産婦人科 1) 、東京医科歯科大学大学院 腎泌尿器外科学 2) 、 亀田総合病院 泌尿器科 3) 、亀田総合病院 ウロギネコロジーセンター 4) 松浦拓人 1) 、森山真吾 2) 、黄鼎文 3) 、岡田義之 4) 、 [16][17][18][19][20] 。術前評価では骨盤MRI検 査のT2強調像において不規則な高信号域を認め る場合は、異型平滑筋腫などの非定型平滑筋腫あ るいは平滑筋肉腫を念頭におかなければならな い 17) 。また、腫瘍にアプローチができれば切除生 検が治療前組織学的診断として有用なこともあ る…”