Journal of Peking University(Health Sciences) ›› 2018, Vol. 50 ›› Issue (6): 1098-1101. doi: 10.19723/j.issn.1671-167X.2018.06.028

• Article • Previous Articles     Next Articles

Clinicopathological analysis of aggressive angiomyxoma of soft tissue in abdomino-pelvic cavity

Lei LIU(),Li-hua WANG,Yu-bo REN,Xiao-song RAO,Shao-min YANG   

  1. Department of Pathology, Peking University International Hospital, Beijing 102206, China
  • Received:2017-07-04 Online:2018-12-18 Published:2018-12-18
  • Contact: Lei LIU E-mail:leids_l@hotmail.com

RICH HTML

  

Abstract:

Aggressive angiomyxoma is a rare mesenchymal tumor. To discuss the clinicopathological characteristics, treatment and prognosis of aggressive angiomyxoma, four cases of aggressive angiomyxoma of soft tissue in abdominopelvic cavity were collected from January 2015 to August 2017 in Peking University International Hospital. The clinical data, imaging examination, histopathological features, immunophenotype, therapy and prognosis were analysed. The related literatures were reviewed. All of the patients were adult females, age range from 27 to 49 years and mean 33 years. The clinical complaint was abdominal distention with no definite predisposing factor, or occasional physical-exam finding with no obvious discomfort. Three cases were primary and one case was recurrent. Typical layered or swirled structural sign was presented by CT and MRI scanning of three cases. All tumors located in the pelvic cavity, and attached to the uterus, vagina, rectum, bladder or ureter. One case was involved in the abdominal cavity simultaneously,adhesive to the spine, inferior vena cava and spleen. The gross appearance of tumors was from 5 to 22 cm in maximum diameter. The sectioned surfaces were soft, solid, white or yellow-gray, focally accompanied by edema, mucoid degeneration or cystic change. Microscopic observation showed that tumor cells were short spindle shaped and little atypical, the stroma was loose like ede-matous mucus or collagen, and the vessels were rich in thin and thick-wall. Partially the vessel wall expressed hyaline degeneration. Also tumors might infiltrate surrounding tissue, such as fat or nerve. The immunohistochemistry results of all cases were estrogen receptor and progesterone receptor diffusely mo-derate positive, Desmin and smooth muscle actin mostly positive, whereas CD34 expressed only in vessel and S-100 protein, CD117 and Dog1 all negative. All the tumors were complete surgical excision. During follow-up, one case recurred the second time. Our conclusions are the diagnosis of aggressive angiomy-xoma is based on pathological morphology supplemented by immunohistochemistry, and the tumor may relapse after surgical resection.

Key words: Myxoma, Pelvic neoplasms, Pathology, clinical, Immunohistochemistry

CLC Number: 

  • R739.9

Figure 1

The section of tumor showed edema, mucinous degeneration"

Figure 2

Tumor cells were short spindle and sparse with rich myxoid stroma and vascular hyaline degeneration (HE ×40)"

Figure 3

Vessels were rich in thin and thick-wall.Reticular fiber staining (A, silver staining ×40) and immunohistochemical staining positive for CD34 (B, EnVision ×40)"

Figure 4

Immunohistochemical staining for tumor (EnVision ×100): A, diffuse nuclear positive for ER; B, diffuse nuclear positive for PR; C, cytoplasm positive for SMA"

[1] Fletcher CDM, Bridge JA, Hogendoorn PCW , et al. World Health Organization classification of tumours of soft tissue and bone [M]. Lyon: IARC Press, 2013.
[2] Zhang JP, Zhu CF . Clinical experiences on aggressive angio-myxoma in China (report of 93 cases)[J]. Int J Gynecol Cancer, 2010,20(2):303-307.
doi: 10.1111/IGC.0b013e3181cc339c pmid: 20134274
[3] Ahmed MA, Uehelie MA, Rage AM , et al. Aggressive angio-myxoma of the penis: the first case report in a 9-month-old infant[J]. Urology, 2017,104(6):187-190.
doi: 10.1016/j.urology.2016.12.045
[4] Surabhi VR, Garg N, Frumovitz M , et al. Aggressive angio-myxomas: a comprehensive imaging review with clinical and histopathologic correlation[J]. Am J Roentgenol, 2014,202(6):1171-1178.
doi: 10.2214/AJR.13.11668 pmid: 24848813
[5] Petscavage-Thomas JM, Walker EA, Logie CI , et al. Soft-tissue myxomatous lesions: review of salient imaging features with pathologic comparison[J]. Radiographics, 2014,34(4):964-980.
doi: 10.1148/rg.344130110 pmid: 25019435
[6] Sun Y, Zhu L, Chang X , et al. Clinicopathological features and treatment analysis of rare aggressive angiomyxoma of the female pelvis and perineum: a retrospective study[J]. Pathol Oncol Res, 2017,23(1):131-137.
doi: 10.1007/s12253-016-0109-y pmid: 27571990
[7] Chen H, Zhao H, Xie Y , et al. Clinicopathological features and differential diagnosis of aggressive angiomyxoma of the female pelvis: 5 case reports and literature review[J]. Medicine (Baltimore), 2017,96(20):e6820.
doi: 10.1097/MD.0000000000006820
[8] 魏红权, 刘珺, 冯晶晶 . 侵袭性血管黏液瘤临床病理观察[J]. 中华医学杂志, 2012,92(22):1553-1555.
doi: 10.3760/cma.j.issn.0376-2491.2012.22.013
[9] Alameda F, Munne A, Baro T , et al. Vulvar angiomyxoma, aggressive angiomyxoma, and angiomyofibroblastoma: an immunohistochemical and ultrastructural study[J]. Ultrastruct Pathol, 2006,30(3):193-205.
doi: 10.1080/01913120500520911 pmid: 16825121
[10] Rawlinson NJ, West WW, Nelson M , et al. Aggressive angio-myxoma with t(12;21) and HMGA2 rearrangement: report of a case and review of the literature[J]. Cancer Genet Cytogenet, 2008,181(2):119-124.
doi: 10.1016/j.cancergencyto.2007.11.008 pmid: 18295664
[11] Jiang XX, Qian LH, Xu HK , et al. Mutation of an X chromosome in aggressive angiomyxoma: Report of a case and review of the literature[J]. Gynecol Oncol Case Rep, 2011,2(2):39-41.
doi: 10.1016/j.gynor.2011.12.001 pmid: 3860615
[12] Bai HM, Yang JX, Huang HF , et al. Individualized managing strategies of aggressive angiomyxoma of female genital tract and pelvis[J]. Eur J Surg Oncol, 2013,39(10):1101-1108.
doi: 10.1016/j.ejso.2013.06.013 pmid: 23899874
[13] Han-Geurts IJ, van Geel AN, van Doorn L , et al. Aggressive angiomyxoma: multimodality treatments can avoid mutilating surgery[J]. Eur J Surg Oncol, 2006,32(10):1217-1221.
doi: 10.1016/j.ejso.2006.06.008 pmid: 16870390
[14] Orfanelli T, Kim CS, Vitez SF , et al. A case report of aggressive angiomyxoma in pregnancy: do hormones play a role[J]. Case Rep Obstet Gynecol, 2016(3):1-4.
doi: 10.1155/2016/6810368
[15] 宫丽华, 孙晓淇, 孟淑琴 , 等. 骨内侵袭性血管黏液瘤的诊断及与其他黏液性骨肿瘤的鉴别[J]. 临床与实验病理学杂志, 2012,28(10):1143-1145.
doi: 10.3969/j.issn.1001-7399.2012.10.019
[16] Schwartz PE, Hui P , McCarthy S. Hormonal therapy for aggressive angiomyxoma: a case report and proposed management algorithm[J]. J Low Genit Tract Dis, 2014,18(2):55-61.
doi: 10.1097/LGT.0b013e3182a22019
[17] Wang Z, Liu Y, Yang L , et al. Maxillary aggressive angiomyxoma showing ineffective to radiotherapy: a rare case report and review of literature[J]. Int J Clin Exp Pathol, 2015,8(1):1063-1067.
pmid: 25755820
[18] Coppola S, Desai A, Tzanis D , et al. Conservative en bloc surgery for aggressive angiomyxoma achieves good local control: analysis of 14 patients from a single institution[J]. Int J Gynecol Cancer, 2013,23(3):540-545.
doi: 10.1097/IGC.0b013e3182843063
[19] Blandamura S, Cruz J, Faure Vergara L , et al. Aggressive angiomyxoma: a second case of metastasis with patient’s death[J]. Hum Pathol, 2003,34(10):1072-1074.
doi: 10.1053/S0046-8177(03)00419-2 pmid: 14608546
[20] Geng J, Cao B, Wang L . Aggressive angiomyxoma: an unusual presentation[J]. Korean J Radiol, 2012,13(1):90-93.
doi: 10.3348/kjr.2012.13.1.90 pmid: 22247641
[1] Dongwu LIU, Jie CHEN, Mingli GAO, Jing YU. Rheumatoid arthritis with Castleman-like histopathology in lymph nodes: A case report [J]. Journal of Peking University (Health Sciences), 2024, 56(5): 928-931.
[2] Yuxuan TIAN,Mingjian RUAN,Yi LIU,Derun LI,Jingyun WU,Qi SHEN,Yu FAN,Jie JIN. Predictive effect of the dual-parametric MRI modified maximum diameter of the lesions with PI-RADS 4 and 5 on the clinically significant prostate cancer [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 567-574.
[3] Zhanhong LAI,Jiachen LI,Zelin YUN,Yonggang ZHANG,Hao ZHANG,Xiaoyan XING,Miao SHAO,Yuebo JIN,Naidi WANG,Yimin LI,Yuhui LI,Zhanguo LI. A unicenter real-world study of the correlation factors for complete clinical response in idiopathic inflammatory myopathies [J]. Journal of Peking University (Health Sciences), 2024, 56(2): 284-292.
[4] Xunmin XU,Xiao SHAO,Aiping JI. Analysis of death cases in the oral emergency department [J]. Journal of Peking University (Health Sciences), 2024, 56(1): 185-189.
[5] Lu FENG,Jia-yu ZHAI,Jin-xia ZHAO. Medical visit status and clinical features in patients with IgG4 related disease [J]. Journal of Peking University (Health Sciences), 2023, 55(6): 1028-1032.
[6] Hui WEI, Ci-dan-yang-zong, Yi-xi-la-mu, Bai-ma-yang-jin. Risk factors associated with different types of Henoch-Schönlein purpura in Tibetan patients at high altitude [J]. Journal of Peking University (Health Sciences), 2023, 55(5): 923-928.
[7] Yun-fei SHI,Hao-jie WANG,Wei-ping LIU,Lan MI,Meng-ping LONG,Yan-fei LIU,Yu-mei LAI,Li-xin ZHOU,Xin-ting DIAO,Xiang-hong LI. Analysis of clinicopathological and molecular abnormalities of angioimmunoblastic T-cell lymphoma [J]. Journal of Peking University (Health Sciences), 2023, 55(3): 521-529.
[8] Li-jia MA,Pan-pan HU,Xiao-guang LIU. Spinal metastases combined with leptomeningeal metastasis: A case report [J]. Journal of Peking University (Health Sciences), 2023, 55(3): 563-566.
[9] Qi SHEN,Yi-xiao LIU,Qun HE. Mucinous tubular and spindle cell carcinoma of kidney: Clinicopathology and prognosis [J]. Journal of Peking University (Health Sciences), 2023, 55(2): 276-282.
[10] Wei-hua HOU,Shu-jie SONG,Zhong-yue SHI,Mu-lan JIN. Clinicopathological features of Helicobacter pylori-negative early gastric cancer [J]. Journal of Peking University (Health Sciences), 2023, 55(2): 292-298.
[11] Xue-mei HA,Yong-zheng YAO,Li-hua SUN,Chun-yang XIN,Yan XIONG. Solid placental transmogrification of the lung: A case report and literature review [J]. Journal of Peking University (Health Sciences), 2023, 55(2): 357-361.
[12] Bo-han NING,Qing-xia ZHANG,Hui YANG,Ying DONG. Endometrioid adenocarcinoma with proliferated stromal cells, hyalinization and cord-like formations: A case report [J]. Journal of Peking University (Health Sciences), 2023, 55(2): 366-369.
[13] Qian SU,Xin PENG,Chuan-xiang ZHOU,Guang-yan YU. Clinicopathological characteristics and prognosis of non-Hodgkin lymphoma in oral and maxillofacial regions: An analysis of 369 cases [J]. Journal of Peking University (Health Sciences), 2023, 55(1): 13-21.
[14] Wen-xin CAI,Shi-cheng LI,Yi-ming LIU,Ru-yu LIANG,Jing LI,Jian-ping GUO,Fan-lei HU,Xiao-lin SUN,Chun LI,Xu LIU,Hua YE,Li-zong DENG,Ru LI,Zhan-guo LI. A cross-sectional study on the clinical phenotypes of rheumatoid arthritis [J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1068-1073.
[15] Rui LIU,Jin-xia ZHAO,Liang YAN. Clinical characteristics of patients with rheumatoid arthritis complicated with venous thrombosis of lower extremities [J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1079-1085.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!