Case ReportA case of multi-modal managed vulval aggressive angiomyxoma diagnosed before conception and monitored during pregnancy
Introduction
Aggressive angiomyxomas are rare, non-malignant tumours of mesenchymal origin occurring primarily in the female pelvis. The primary management is tumour excision. However, other non- surgical modalities have been employed, such as radiotherapy, embolisation, GnRH analogues or other anti-estrogenic agents. These tumours often have ER and PR positive receptors with presumably a hormonally driven growth pattern. Thus with preg- nancy, the potential for enhanced growth is of concern. We report our experience of a patient with an aggressive angiomyxoma sensitive to GnRH analogues who subsequently became pregnant. We describe the progression of her disease prior to and during her pregnancy.
Section snippets
Case
A nulliparous, 22 year old woman was admitted in July 2006 for marsupialisation of a suspected right Bartholin's cyst. Intraoperative biopsies were taken and histopathology results indicated a possible aggressive angiomyxoma. The patient was therefore referred to Oxford Gynaecological Cancer Centre and seen in August 2006.
On examination, there was an 8 cm protruding lesion in the region of the right Bartholin's gland which had surface necrosis. In view of the indeterminate histology, she
Discussion
Nine other cases of aggressive angiomyxoma have been reported during pregnancy. This case is the first to closely monitor tumour growth before, during and after pregnancy.
Angiomyxomas' growth during pregnancy and reproductive years in addition to high levels of estrogenic and progestogenic positivity on histology led to the theory that these tumours are hormone dependent [2,3]. The pattern of growth and response to treatment in this case also supports this association. However, despite concerns
Conflict of interest
No conflicting interests.
Acknowledgment
Thanks to Niall Moore, Consultant Radiologist, for reporting the scans and the help in preparing the images for the case report.
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Aggressive angiomyxoma: multimodality treatments can avoid mutilating surgery
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Aggressive angiomyxoma of the vulva in pregnancy: a case report and review of management options
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Cited by (11)
Primary surgical treatment of pelvic aggressive angiomyxoma is not always advisable in ER positive patients
2014, European Journal of Surgical OncologyAggressive angiomyxoma.
2013, Diagnostic and interventional imagingCitation Excerpt :There is no cytonuclear atypy or mitosis. The tumour cells express the hormone receptors to œstrogens and progesterone, thereby confirming the hormone-dependent nature of this lesion [4]. Therefore, the use of GnRH agonists, such as leuprorelin (Enantone®), is justified to inhibit the pituitary secretion of gonadotropins (FSH/LH).
Aggressive angiomyxoma: A case series and literature review
2010, European Journal of Surgical OncologyCitation Excerpt :Seven of these cases were directly managed in our centre while the others were referred for expert opinion only. Among the seven, one interesting case of AA in a pregnant woman (case 1 – Table 1) has previously been reported separately.6 We also performed a MEDLINE search from 1983 to July 2009 with the key words “aggressive” and “angiomyxoma” and reviewed relevant literature.
Aggressive angiomyxoma of pelvis: A case report and literature review
2022, Medicine (United States)