Perianal aggressive angiomyxoma in a male patient

Abstract is not required for Clinical Imagesis not required for Clinical Images (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 6 No. 7, July 2015. ISSN – [0976-3198] Int J Case Rep Images 2015;6(7):454–456. www.ijcasereportsandimages.com ALHumoud et al. 454 CASE REPORT OPEN ACCESS Perianal aggressive angiomyxoma in a male patient Zainab Taha ALHumoud, Najla Aldaoud, Hussain Abrar, Amro Salem


CliNiCAl imAgES PEER REviEwEd | OPEN ACCESS
cut surface ( Figure 3). Microscopically, it showed an illdefined tumor composed of small spindle cells embedded in an abundant myxoid stroma interspersed with a thick wall and hyalinized blood vessels. There was no evidence of mitotic activity or nuclear atypia ( Figure 4A-C). Based on these histological features, a diagnosis of aggressive angiomyxoma (AAM) was confirmed.

DIsCUssIoN
Aggressive angiomyxoma (AAM) is a rare benign soft tissue tumor of mesenchymal origin, characterized by its locally infiltrative nature and high recurrence rate. It was given this name due to the pathological findings of the stellate and spindled cells, along with variable-sized blood vessels, which were intricately entwined within a myxoid matrix [1]. This presentation occurs predominantly in woman of reproductive age (female to male ratio of approximately 6:1), and exclusively in the pelvi-perianal region. To our knowledge, only 43 cases occurring in men have been reported in literature [1]. In men, AAM usually involves the scrotum (38%), spermatic cord (33%), and perineal region (13%) [2].
Although clinical diagnosis of AAM may be difficult, the typical MRI features of AAM are swirled strands, aligned with the craniocaudal axis. This particular imaging feature is caused by a stretching of the fibrovascular stroma [3]. Confirmation of diagnosis is based on a histopathology study. AAM should be distinguished from other benign, potential lesions with low local recurrence, and malignant tumors with widespread metastatic potential.
Surgery is the mainstay of treatment for AAM, although achieving negative resection margins is complicated, because of the infiltrative nature of the tumor. Local recurrence rate falls between 36% and 72% and is usually seen in the first three years. Recurrences of the disease are usually controlled with surgery [1]. Several reported attempts at using chemotherapy and radiotherapy as part of the treatment protocol for AAM have proved disappointing; probably due to the low mitotic activity/ growth fraction of cells. Primary treatment with GnRH agonists has proved successful, as many of angiomyxoma are positive for estrogen and progesterone receptors [4]. However, the duration of the responses and an optimal treatment schedule are still unknown [1].

CoNCLUsIoN
In conclusion, whether the treatment of aggressive angiomyxoma (AAM) is surgery, hormonal therapy or a combination of the two, it is apparent that adequate management of AAM necessitates close, and longterm follow-up at sixth month intervals, to monitor for recurrence. Multiple relapses can occur but metastases are unusual.

AN INTRODUCTION
Edorium Journals: On Web

About Edorium Journals
Edorium Journals is a publisher of high-quality, open access, international scholarly journals covering subjects in basic sciences and clinical specialties and subspecialties.

Edorium Journals: An introduction
Edorium Journals Team

But why should you publish with Edorium Journals?
In less than 10 words -we give you what no one does.

Vision of being the best
We have the vision of making our journals the best and the most authoritative journals in their respective specialties. We are working towards this goal every day of every week of every month of every year.

Exceptional services
We care for you, your work and your time. Our efficient, personalized and courteous services are a testimony to this.

Editorial Review
All manuscripts submitted to Edorium Journals undergo pre-processing review, first editorial review, peer review, second editorial review and finally third editorial review.

Peer Review
All manuscripts submitted to Edorium Journals undergo anonymous, double-blind, external peer review.

Early View version
Early View version of your manuscript will be published in the journal within 72 hours of final acceptance.

Manuscript status
From submission to publication of your article you will get regular updates (minimum six times) about status of your manuscripts directly in your email.

Most Favored Author program
Join this program and publish any number of articles free of charge for one to five years.

Favored Author program
One email is all it takes to become our favored author. You will not only get fee waivers but also get information and insights about scholarly publishing.

Institutional Membership program
Join our Institutional Memberships program and help scholars from your institute make their research accessible to all and save thousands of dollars in fees make their research accessible to all.

Our presence
We have some of the best designed publication formats. Our websites are very user friendly and enable you to do your work very easily with no hassle.

Something more...
We request you to have a look at our website to know more about us and our services.
We welcome you to interact with us, share with us, join us and of course publish with us.

Invitation for article submission
We sincerely invite you to submit your valuable research for publication to Edorium Journals.

Six weeks
You will get first decision on your manuscript within six weeks (42 days) of submission. If we fail to honor this by even one day, we will publish your manuscript free of charge.

Four weeks
After we receive page proofs, your manuscript will be published in the journal within four weeks (31 days). If we fail to honor this by even one day, we will publish your manuscript free of charge and refund you the full article publication charges you paid for your manuscript.