PMC9748652_01
Imaging and gross pathology of the deep angiomyxoma. (A) Axial, enhanced, T2-weighted MRI scan indicating a high-signal intensity tumor displacing the pelvic organs to the right (arrow). (B) Sagittal, enhanced, T2-weighted MRI scan indicating a 14-cm in the longest axis, nodular, structured tumor extending from the vulva to the paravesical space with swirled and layered strands of lower signal intensity (arrow). (C) The gross appearance is elastoplastic and soft, with a glistening and gelatinous surface. (D) Close-up of C.
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Pelvic MRI (3.0T MRI MAGNETOM Skyra VE11C; Siemens AG; scan time, 2:42; repetition time, 4,000 msec; echo time, 90 msec; turbo factor, 15; band width, 302 Hz/px; slice thickness, 3 mm; field of view, 25x25 cm; matrix size, 0.6x0.6 mm; Parallel Imaging, GRAPPA 2) indicated a nodular, structured tumor with a maximum diameter of 14 cm (Fig. 1A). The tumor, which had a swirled and layered pattern according to T2-weighted MRI, extended from the left vulva subcutaneously to the paravesical space (Fig. 1B). The tumor was resected en bloc without any adjunct organ injuries and weighed 480 g (Fig. 1C). Macroscopically, the resected tumor was not well-defined, elastoplastic and soft with a glistening and gelatinous surface (Fig. 1D).
Tumor pathology and hormone receptor expression. (A) The tumor is comprised loose fibromyxoid stroma, fine collagen fibers and prominent vessels, according to H&E staining (original magnification, x4; scale bar, 500 microm). (B) High-power photomicrograph indicates the proliferation of mildly atypical spindle-shaped cells according to H&E staining (original magnification, x40; scale bar, 500 microm). Immunoreactivity for (C) estrogen receptor (D) progesterone receptor is positive, (E) desmin, (F) alpha-smooth muscle actin and (G) CD34 (original magnification, x20; scale bar, 100 microm).
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Pathological diagnosis indicated DAM against a background of sparse connective tissue with a mucous matrix (Fig. 2A) and mildly atypical spindle-shaped cell proliferation (Fig. 2B). PgR (cat. no. 790-4296; dilution, 1:1; Ventana Medical Systems, Inc.; Fig. 2D) and desmin (cat. no. PA0033; dilution, 1:1; Leica Microsystems GmbH; Fig. 2E). PA0943; dilution, 1:1; Leica Microsystems GmbH; Fig. 2F) and CD34 (cat. no. PA0212; dilution, 1:1; Leica Microsystems GmbH; Fig. 2G).