Chatzigrigoriadis Christodoulos, Tatanis Vasileios, Spinos Theodoros, Peteinaris Angelis, Samaras Angelos, Thanos Anastasios, Liatsikos Evangelos, Kallidonis Panagiotis
School of Medicine, University of Patras, 26504 Patras, Greece.
Department of Urology, University Hospital of Patras, 26504 Patras, Greece.
Clin Pract. 2024 Dec 13;14(6):2705-2712. doi: 10.3390/clinpract14060213.
Deep or aggressive angiomyxoma is an uncommon neoplasm of the pelvis. Although deep angiomyxoma is a benign tumor, its tendency to infiltrate soft tissues and reach a large size (typically > 10 cm) indicates aggressive biological behavior. It is usually present in female patients, but there have been recent reports of male-aggressive angiomyxoma. While rare, it is an important consideration in patients with a pelvic mass. The clinical presentation is non-specific; patients are either asymptomatic or present with non-specific complaints, such as dull pain, constipation, and dysuria. It is commonly mistaken for an inguinal hernia, hydrocele, testicular cancer, lipoma, and epididymal cyst in male patients, thus misguiding the management of these cases. Hence, preoperative evaluation with imaging studies (ultrasound, computed tomography, magnetic resonance imaging) and biopsy allows for an accurate diagnosis and treatment. Currently, the standard of treatment is surgical resection of the tumor with free margins. The role of hormone therapy is under investigation for patients with deep angiomyxoma positive for estrogen/progesterone receptors. Regular follow-up is necessary given the high recurrence rate of deep angiomyxoma (9-72%). We present a case of an elderly man who presented with hematuria due to urolithiasis and an asymptomatic inguinal mass mimicking an inguinal hernia. A computed scan (CT) of the abdomen confirmed the presence of the mass, which was removed surgically. The pathologic examination of the tumor was consistent with deep angiomyxoma. The diagnosis of deep angiomyxoma should always be considered in patients with an inguinal mass to avoid delayed treatment and incomplete surgical excision.
深部或侵袭性血管黏液瘤是一种罕见的盆腔肿瘤。尽管深部血管黏液瘤是良性肿瘤，但其浸润软组织并长得很大（通常>10厘米）的倾向表明其具有侵袭性生物学行为。它通常见于女性患者，但最近有男性侵袭性血管黏液瘤的报道。虽然罕见，但在有盆腔肿块的患者中是一个重要的考虑因素。临床表现不具特异性；患者要么无症状，要么表现为非特异性症状，如钝痛、便秘和排尿困难。在男性患者中，它常被误诊为腹股沟疝、鞘膜积液、睾丸癌、脂肪瘤和附睾囊肿，从而误导这些病例的治疗。因此，通过影像学检查（超声、计算机断层扫描、磁共振成像）和活检进行术前评估有助于准确诊断和治疗。目前，治疗的标准是手术切除肿瘤并获得切缘阴性。对于雌激素/孕激素受体阳性的深部血管黏液瘤患者，激素治疗的作用正在研究中。鉴于深部血管黏液瘤的高复发率（9%-72%），定期随访是必要的。我们报告一例老年男性患者，因尿路结石出现血尿，并伴有一个无症状的腹股沟肿块，类似腹股沟疝。腹部计算机断层扫描（CT）证实了肿块的存在，该肿块通过手术切除。肿瘤的病理检查结果与深部血管黏液瘤一致。对于有腹股沟肿块的患者，应始终考虑深部血管黏液瘤的诊断，以避免治疗延迟和手术切除不彻底。
