Aggressive angiomyxoma (AAM) is a rare, benign tumor. It usually involves the connective tissue of the perineal regions in women of reproductive age. In this report, we present a case of AAM in a 66-year-old female, which presented itself as a retrovesical tumor on pelvic magnetic resonance imaging and caused lower urinary tract symptoms.
CASE REPORTA 66-year-old female patient underwent abdominal pelvis ultrasonography (A-P sono) for a routine check. The A-P sono showed a mass between the urinary bladder and the vagina. For further evaluation of this mass, the patient visited the Department of Urology. She presented with frequency of urination and nocturia of three times per night. Her voiding diary showed that her functional bladder capacity was less than 200 ml. Upon physical examination, her abdomen was soft and movable and there was no tenderness. The mass was palpable through the vagina, and it was soft and round. The laboratory findings were within normal limits and her tumor markers, such as CA 19-9, AFP, and CEA, were within normal ranges. Transvaginal ultrasonography (TVUS) and pelvic MRI were performed.TVUS revealed a 5.1x4.7x3.4 cm sized homogeneous mass that was compressing the urinary bladder (Fig. 1A, B). On the pelvic MRI, the tumor was located in the retrovesical space and it was thought to be arising from the retrovesical tissue, such as the bladder, vagina, or uterus. However, we could not rule out that the tumor might have originated from the urethra. On the T1-weighted image, the tumor was of homogeneous and low intensity, similar to the image of the muscles. On the T2-weighted image, the mass was heterogeneous and of intermediate intensity (Fig. 1C, D). The tumor was thought to be a leiomyoma, a rhabdomyosarcoma, or a neurogenic tumor, as suggested by these MRI findings.In the operation field, the tumor was adhered to the posterior bladder wall. However, it was easily separated from the bladder wall and was resected en bloc. The resected tumor was 5.5x4x3 cm in size. Grossly, the tumor had a soft, smooth and elastic surface (Fig. 2). The cut surface showed whitish-yellow homogeneous lesions. Microscopically, the mass was made up of rather well-demarcated tumor tissues, which showed low cellularity of relatively uniform, small, satellite and spindly cells that were set in a loosely collagenous, myxoid matrix with scattered vessels of varying caliber. The tumor cells had scant, pale, eosinophilic cytoplasm with poorly defined borders and relatively bland nuclei with open chromatin and a single, small