Elsevier

Gynecologic Oncology

Volume 115, Issue 1, October 2009, Pages 170-171
Gynecologic Oncology

Case Report
A case of multi-modal managed vulval aggressive angiomyxoma diagnosed before conception and monitored during pregnancy

https://doi.org/10.1016/j.ygyno.2009.05.035Get rights and content

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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