Angiomyofibroblastoma mimicking an inguinal hernia: a challenging diagnosis in a male patient

Abstract

Introduction Angiomyofibroblastoma is a rare benign myofibroblastic neoplasm which mainly occurs in the soft tissues of the pelvi-perineal region of females. Aim To present an unusual case of angiomyofibroblastoma mimicking an inguinal hernia in a 62-year-old male. Material and methods The patient was hospitalized with an irreducible, painless inguinal mass and surgical intervention for inguinal hernia was decided. The well-defined nodular mass was sent for histological examination. Results Under microscope, proliferation of spindle and oval cells around thin-walled vessels was observed, being intermingled with mature adipocytes. We did not identify necrosis, haemorrhage, cytologic atypia or mitotic figures. The tumour cells displayed positivity for desmin, vimentin, CD34, oestrogen and progesterone receptors, a low Ki67 index and unusual nuclear positivity for c-theta (PKCθ). They were negative for smooth muscle actin (SMA), S100, CD44, maspin, synaptophysin, DOG1 and CD117. The case was diagnosed as angiomyofibroblastoma, the main challenge being the differential diagnosis with aggressive angiomyxoma, which can present a similar histologic aspect and immunophenotype and recurs more frequently. No recurrences were observed 8 months after the surgery. Conclusions Angiomyofibroblastoma should be included in the differential diagnosis of inguinal hernia. This is the fourteenth case of angiomyofibroblastoma diagnosed in males.

Case Report: Magnetic Resonance Imaging Features of Scrotal Angiomyofibroblastoma (AMF) With Pathologic Correlation

“…Angiomyofibroblastoma is a rare benign soft-tissue neoplasm that belongs to the mesenchymal tumor class (3,4). Its clinical course is usually characterized by slow and painless growth (1).…”

“…The enhancement pattern of the MRI findings is consistent with the other two female cases (7,8), one in the posterior perivesical space and the other in the paravaginal space. These manifestations may correlate with the rich supply of capillary-like blood vessels in it, or due to the contrast medium is difficult to be quickly washed out from a large number of fibrous tissues (3,7). Besides, the well-defined boundary and unrestricted diffusion on DWI might indicate a low-grade tumor.…”

“…Though AMF is a rare tumor that most commonly affects women (1), it also occurs in men and can arise in the inguen, scrotum, spermatic cord, and bladder (2). Only 23 cases of male AMF were reported in the English-language literature based on a review of PubMed data since 1992 (3). We also found that the MRI performances of AMF in men have rarely been reported.…”

Angiomyofibroblastoma férfiban – egy ritka paratesticularis eltérés és irodalmi áttekintés

“…Emiatt fontos a műtéti radikalitás, agresszív angiomyxoma esetén a komplett reszekció elengedhetetlen [22]. Az agresszív angiomyxoma és az angiomyofibroblastoma együttes fennállása is előfordulhat, ilyenkor is számítani kell a kiújulásra [23].…”