Pelvic Soft Tissue Aggressive Angiomyxoma

Amante, S; Sousa, Rafaela; Amaral, Rui

doi:10.5334/jbsr.2230

Cited by 4 publications

(3 citation statements)

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“…Among the imaging modalities, an MRI scan is the best imaging technique to characterise the mass and aids in surgical planning by determining the extent of its growth. The typical appearance of AAM on MRI scans on T1-weighted images may be that of a "swirled" or "whorled" appearance with low or equal signal and high signal on T2-weighted images (1,3). Surgical resection of angiomyxomas has been the main treatment modality with the aim of obtaining negative margins to reduce the risk of local recurrences (4,11).…”

Section: Discussionmentioning

confidence: 99%

“…The rate of local recurrence has been reported to range from 25% to 47% and is mainly thought to be due to inadequate excision (4,13,14). Alternative treatment options include hormonal therapy due to the high prevalence of ER and PR positivity among AAMs (1)(2)(3)(4)(8)(9)(10)(11)(12). The use of gonadotrophinreleasing hormone (GnRH) agonist or aromatase inhibitors have been reported to reduce the size of the tumours before surgery or as adjuvant therapy to reduce recurrence risk (2,(15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

“…Aggressive angiomyxomas (AAM) are rare mesenchymal neoplasms that tend to grow in the pelvis and perianal regions (1)(2)(3)(4)(5)(6)(7)(8)(9). They occur more frequently in premenopausal than postmenopausal women, with a peak incidence in the forties (2,3).…”

Section: Introductionmentioning

confidence: 99%

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Single-port laparoscopic and transvaginal resection of a large pelvic aggressive angiomyxoma: a case report

Ng¹,

Wu²,

Nadarajah³

2022

AME Surg J

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Background: Aggressive angiomyxomas (AAM) are rare mesenchymal neoplasms that occur more commonly in women. The mainstay of treatment is surgical excision which can be performed via various approaches. However, there are limited reports on minimally invasive surgeries in the treatment of AAM.We report a successful case of single-port laparoscopic and transvaginal resection of a pelvic AAM.Case Description: Our patient was a 45-year-old female who presented with symptomatic anaemia from menorrhagia and a vaginal lump of one year's duration that was worsening and affecting her quality of life (QOL). There was a 20 cm prolapsed, reducible smooth mass from the vagina on examination. An magnetic resonance imaging (MRI) scan showed a 23.9 cm × 12.7 cm × 8.4 cm extraperitoneal, mildly enhancing soft tissue mass sited between the uterus, vagina anteriorly and the rectum posteriorly, with a significant prolapsed component which showed no overt infiltration or invasion into the adjacent structures or sacrococcygeal spine. She underwent a single-port laparoscopic total hysterectomy, bilateral salpingectomies, and resection of the retroperitoneal mass. Intra-operatively, the uterus was 12 weeks in size. There was a large retroperitoneal mass on the right side, of which 40 cm had prolapsed through the vagina. The mass extended to the right common iliac vessels and down to the Pouch of Douglas. It was adherent to the pelvic sidewall, ureters, and retroperitoneal space. There was no direct involvement of the uterus, bowels, or ureters. The patient recovered well postoperatively, and the histology of the mass was an AAM that was strongly positive for oestrogen and progesterone receptors. To date, the prognosis was good as the woman was well with no recurrence for two and a half years. She regained her QOL. She will need to continue her follow-up to assess the long-term prognosis.Conclusions: A minimally invasive approach is increasingly used in various oncological surgeries, especially gynaecology oncological cases. Our case demonstrates that a combination of single-port laparoscopic and transvaginal techniques can be performed with the benefits of complete enucleation and resection of the tumour, less scarring and lesser postoperative pain. This study provides a possible alternative surgical procedure for patients with AAM that experienced surgeons can perform safely.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Single-port laparoscopic and transvaginal resection of a large pelvic aggressive angiomyxoma: a case report

Ng¹,

Wu²,

Nadarajah³

2022

AME Surg J

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Aggressive angiomyxoma of the pelvis surgical management in a case with delayed diagnosis

Akhavan

Nikfar

Behboudi

et al. 2021

International Journal of Surgery Case Reports

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Clinicopathological characteristics and prognosis analysis of Aggressive angiomyxoma: A Retrospective Study

You

Wang

et al. 2022

Preprint

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Background: Aggressive angiomyxoma is a rare, locally invasive mesenchymal neoplasm with a high recurrence rate. However, our current research on the clinical characteristics, therapeutic strategies and prognosis of aggressive angiomyxoma is limited. This study aimed to improve the management of aggressive angiomyxoma by evaluating the clinicopathological characteristics, therapeutic strategies, and prognostic factors associated with aggressive angiomyxomas. Methods: Retrospectively analyzed the medical records of patients histopathologically diagnosed with aggressive angiomyxomas from May 2005 to January 2022. Data related to clinicopathological characteristics, therapeutic strategies, and survival time were recorded and analyzed. Survival and prognosis analyses were carried out to identify variables significantly associated with the outcomes. Results: fourteen patients were included in the study with a median follow-up of 78.8 months. Univariate Cox regression analysis identified tumor margin (P=0.012) and initial treatment site (P=0.039) as associated with disease-free survival (DFS). The Kaplan-Meier survival curve showed that tumor margin had a greater effect on the prognosis of patients. Patients with positive tumor margins had a significantly lower probability of survival with DFS than those with negative margins (HR= 3.41, CI:2.73-15.74, P=0.012). Meanwhile, we found that patients who underwent surgery in other hospitals had a lower probability of survival with DFS. This difference in survival was statistically significant (HR=1.48, CI:1.09-2.50, P=0.039). To further demonstrate the results of this study, we constructed a Nomogram model. The results showed that the tumor margin and initial treatment site had the greatest effect on patient prognosis and the greatest contribution to risk score, which confirmed the results of Kaplan-Meier survival curve analysis. Conclusion: Tumor margin and initial treatment site are closely associated with prognosis in aggressive angiomyxomas. Radical resection with negative tumor margins is the first choice of treatment for aggressive angiomyxomas. Patients with aggressive angiomyxomas should go to the comprehensive authoritative hospitals to obtain definitive diagnosis and effective treatment in in earlier stage. Furthermore, Patients with aggressive angiomyxomasrequire long-term follow-up, especially within three years after surgery.

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Pelvic Soft Tissue Aggressive Angiomyxoma

Abstract: Teaching Point: Aggressive angiomyxoma is a rare and benign soft tissue lesion, characterized by a “whorled” or “layering” appearance on T2-weighted and post-gadolinium magnetic resonance.

Cited by 4 publications

References 1 publication

Single-port laparoscopic and transvaginal resection of a large pelvic aggressive angiomyxoma: a case report

Single-port laparoscopic and transvaginal resection of a large pelvic aggressive angiomyxoma: a case report

Aggressive angiomyxoma of the pelvis surgical management in a case with delayed diagnosis

Clinicopathological characteristics and prognosis analysis of Aggressive angiomyxoma: A Retrospective Study

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