aggressive angiomyxoma

Radiologic
imaging findings of pelvic aggressive angiomyxoma correlated with surgical and pathological features. a, c Sagittal sonographic view of the lesion shows fibrillary internal structure (arrows). b Axial ultrasound image showing depth of the heterogenous hypoechoic lesion. d The lesion causes anterior displacement of uterus and urinary bladder at the suprapubic level
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Radiologic
imaging findings of pelvic aggressive angiomyxoma correlated with surgical and pathological features. a Axial contrast enhanced computed tomography images shows subtle swirled enhancing tissue internally (arrow). b Sagittal tomographic image reveals the extent of the lesion that starts from L2 vertebra level and goes down below the pelvic floor. c Axial image showing left lateral displacement of rectum (arrow) and anterior displacement of uterus due to the compressive feature of the lesion (double arrows). d Coronal oblique tomographic view shows the lesion extending below the pelvic floor
ejrnm.springeropen.com • CC-by-4.0
Radiologic
imaging findings of pelvic aggressive angiomyxoma correlated with surgical and pathological features. a, b Sagittal and coronal T2 weighted image indicates laminated pattern resulting from collagen fibrils (arrows). c T1 weighted axial image without contrast shows left lateral rectal displacement (arrow) and anterior uterine displacement (double arrows). d Axial contrast enhanced T1 weighted image shows intense enhancement pattern
ejrnm.springeropen.com • CC-by-4.0
Aggresive
angiomyxoma: Typical findings on MRI. A well-defined lesion in the paravaginal and parametrial right area is observed (red arrows). This lesion is hyperintense and heterogeneous on T2WI, observing multiple hypointense strands within it (swirled appearance).
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Aggresive
angiomyxoma: Typical findings on MRI. The tumour displaces the vagina towards the left side but without invading its wall (blue arrows). Note the swirled appearance of this lesion with multiple hypointense strands within it (green arrow).
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Aggresive
angiomyxoma: Typical findings on MRI. A finger-like projection of this lesion infiltrates the right puborectal muscle reaching the ischio-anal fossa. The presence of this projections invading neighbouring tissues and structures (yellow arrow) suggests a locally aggressive behaviour of this lesion.
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Aggresive
angiomyxoma: Typical findings on MRI. The lesion is clearly in contact with the internal obturator muscle (green arrow), without infiltrating it.
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Aggresive
angiomyxoma: Typical findings on MRI. After contrast injection, the lesion shows a progressive and heterogeneous enhancement.
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A case of
recurrent aggressive angiomyxoma. Axial CT at the level of the bladder shows the mass lesion displacing the rectum and bladder with preserved fat planes. The ureter appears to course through the mass without evidence of invasion.
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A case of
recurrent aggressive angiomyxoma. Axial section just below the level of the aorta bifurcation showing displacement of bowel loops and compression of bilateral common iliac arteries without signs of invasion.
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A case of
recurrent aggressive angiomyxoma. USG shows the hypoechoic mass lesion with dilated ureter coursing through the lesion and displacement of bladder with foley"s bulb and rectum without signs of invasion.
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Aggressive angiomyxomas are rare tumors that arise in the pelvis and typically cross the levator ani muscles. Despite its name, it is essentially a benign tumor and the term "aggressive" is due to a predilection for local recurrence. Only rarely does it metastasize.

Epidemiology

It is seen predominantly in women (>90%) in the second through fourth decades of life .

Pathology

Aggressive angiomyxoma is a mesenchymal tumor that arises from connective tissue.

Radiographic features

Classically shows involvement of both pelvic and perineal compartments. In males, it may involve the inguinoscrotal region .

CT

On CT, it usually presents as a well-defined mass with attenuation less than or equal to that of adjacent skeletal muscle. It often has swirled enhancing tissue internally .

MRI

Reported signal characteristics of the lesion include:

  • T1: tends to be iso to low signal
  • T2: predominantly high signal and typically has a swirled appearance

Due to the presence of collagen fibrils in the myxoid tissue, a laminated pattern may be seen on T2W images and post contrast T1 images, with alternating hyper- and hypointense linear areas . Rarely, cystic degeneration and intratumoral vessels may be seen .

Treatment and prognosis

Surgical resection with long term follow up is the treatment of choice. The "aggressive" tumor is infiltrative, so chances of local recurrence are high .

In ER and PR positive cases, hormonal therapy is also found to be helpful .

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu aggressives Angiomyxom:
aggressives
Angiomyolipom
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