Application of ultrasound in aggressive angiomyxoma: Eight case reports and review of literature

Abstract

Aggressive angiomyxoma (AAM) is a rare tumour that often occurs in soft tissues of the female genital tract. Eight cases of AAM are reported in this article, and the clinical features and ultrasound and magnetic resonance imaging (MRI) results of the eight cases are reviewed and summarized. The main complaints of all the patients were palpable and painless masses in the vulva or scrotum. The lesions were mainly located in the vulva, pelvis, and perineal region, with a large scope of involvement. The sonographic features of AAM were characteristic. On sonography, all of the masses were of irregular shape and showed hypoechogenicity, with a heterogeneous inner echotexture. Intratumoural and peritumoural blood flows were detected by colour Doppler imaging. On real-time ultrasonic imaging, prominent deformation of the lesions was observed by compressing the masses with the probe. Some special imaging features were also revealed, including a laminated or swirled appearance of inner echogenicity, and a finger-like or tongue-like growth pattern. On MRI imaging, the lesions showed intermediate-intensity signals and intermediate to high-intensity signals on TI-weighted and T2-weighted sequences. A rapid and uneven enhancement pattern was demonstrated. After the comparison of sonographic features with MRI and pathological findings, we found the relevance of the ultrasonographic characteristics with MRI and histological features of AAM. Ultrasound can be a valuable imaging method for the preoperative diagnosis, evaluation of scope, and follow-up of AAM.

Aggressive Angiomyxoma in the Scrotum: A Case Series and Literature Review

“…Some AAMs presented as heterogeneous mixed hypoechoic masses, which may due to different tissue density and interstitial edema, as well as local mucoid degeneration or cystic change. CDFI was able to detect a rich blood flow signal inside and around the tumor, which may be associated with characteristic vascular components of AAM ( 33 ). On a plain CT scan, it is expressed as a low-density shadow relative to the muscle tissue and swirling or stratified mild enhancement on enhanced CT ( 34 ).…”

Histopathologic diagnosis of aggressive angiomyxoma following removal of an asymptomatic, stable vulvar mass

“…Diagnosis can be attempted with imaging modalities such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI), although there are no current guidelines. In a case report involving eight patients, Zhao et al published the most thorough description of ultrasonographic appearance of AAM [7]. These masses have increased vascularity on color Doppler and are described as hypoechoic, with swirls of iso-or hyperechoic parts due to myxoid components.…”

“…The tumors also tend to have fingerlike projections into neighboring tissue, demonstrating the aggressive and invasive nature. Upon dissection of AAM tumors, the tissue is soft and rubbery, with deformity upon ultrasound probe compression [7]. Due to ultrasound's high reliance on user ability, CT and MRI have also been studied as a diagnostic tool.…”

Angiomyofibroblastoma férfiban – egy ritka paratesticularis eltérés és irodalmi áttekintés

“…Jellegzetesége az örvényes, ujjszerű mintázat. Color-Dopplerrel tumoron belüli és tumor körüli vascularisatio is észlelhető [22]. Az agreszszív angiomyxoma kiújulási hajlama magas, az esetek 47%-ában ép reszekciós szél esetén is kiújulhat [9].…”

“…Az agreszszív angiomyxoma kiújulási hajlama magas, az esetek 47%-ában ép reszekciós szél esetén is kiújulhat [9]. Emiatt fontos a műtéti radikalitás, agresszív angiomyxoma esetén a komplett reszekció elengedhetetlen [22]. Az agresszív angiomyxoma és az angiomyofibroblastoma együttes fennállása is előfordulhat, ilyenkor is számítani kell a kiújulásra [23].…”