PMC3773457_01
(a) Axial noncontrast CT image showing vulvar skin edema (arrow) and the suspected aggressive angiomyxoma at its anterior origin. (b) Axial CT image with contrast showing the posterior extent of the aggressive angiomyxoma with the swirled appearance (arrow) and the attenuation difference between it and surrounding skeletal muscles; less attenuation compared to skeletal muscle (asterisk).
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fig1
This lesion was localized within the vulva and did not extend beyond the pelvic diaphragm (Figure 1).
Intraoperative image delineating the borders of the vulvar AA (arrows) and the clitoral hood (asterisk).
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fig2
The patient had an uneventful intraoperative course with complete excision of this mass (Figure 2) and an estimated blood loss of 150cc.
Gross vulvar AA: well-circumscribed and well-encapsulated fleshy tan gelatinous mass.
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fig3
On gross examination, the mass comprised of soft tissue measuring up to 16 cm in diameter and was well circumscribed (Figure 3).
(a) Low-power (10x) H&E slide showing widely scattered bland spindle cells within a myxoid background (asterisk) with accompanying vascular structures (arrows). (b) High-power (40x) H&E slide showing bland spindle cells (white arrows) scattered within a myxoid background and nearby vascular structures (black arrow).
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fig4
The final pathology using H&E staining showed widely scattered bland spindle cells with ill-defined cytoplasm within a myxoid background with accompanying thin and thick-walled vascular structures all of which are characteristic of an aggressive angiomyxoma (Figure 4).