Aggressive Angiomyxoma of the Ischiorectal fossa presenting as a huge pedunculated Mass: A Case Report and Review of the Literature

Abstract

We report a 49- year old multiparous pre-menopausal woman who presented with a 2-year history of a painless pedunculated mass in the left side of the ischiorectal fossa. Clinical examination showed a well-preserved middle-aged woman with a mass measuring 10x5.5 cm and a short stalk (2.5x1.2cm) attaching it to the ischiorectal fossa distorting the left side of the perineum. The tumour was excised, and histopathological examination of the specimen performed. Microscopically, sections showed many walled vessels of various sizes, surrounded by a loose fibro- myxoid collagenous stroma having stellate spindle-shaped nuclei and wavy cytoplasm. Aggressive angiomyxoma should be distinguished from the benign and malignant myxoid tumors or tumor-like conditions of the perineum. The pathologic and  immunohistochemical characteristics, the difficulties in determining the differential diagnosis and the treatment of this tumor are discussed. Also, the international literature is reviewed.