Aggressive angiomyxoma

Case contributed by Dr Ammar Ashraf

Presentation

Right scrotal swelling/mass for 7 months. Gradually increasing in size. No history of pain, fever or trauma.

Patient Data

Age: 50 years
Gender: Male
Ultrasound

A large heterogeneous, predominantly echogenic, lobulated extra-testicular mass measuring 13.0 x 8.0 x 8.5 cm, displacing the testicles superiorly and laterally, is seen in the right hemiscrotum. Increased vascularity is noted in it on color Doppler ultrasound examination. Testicles are normal. Minimal right hydrocele.

Mildly hyper vascular right hemi scrotal mass; it is extra testicular in location and most likely represents a neoplastic lesion, like sarcoma. Other possible differentials include mesothelioma of the tunica vaginalis and adenomatoid tumor of the scrotum. Further evaluation with MRI was recommended, which was however not done. 

Laboratory investigations including tumor markers (AFP, LDH and B-HCG) were negative.

Case Discussion

Procedure: Right para-testicular mass excision.

Gross description: Specimen submitted in one container, in formalin, labeled "right scrotal mass" comprises two irregular masses; the larger mass measures 16.5 x 12 x 5 cm and the smaller mass (spermatic cord) measures 6 x 4 x 1.2 cm. They weigh altogether 532 grams. On slicing, the larger mass is myxoid and slightly vascular. No testicular tissue is seen in it grossly.

Microscopic description: The tumor is composed of widely scattered spindle and stellate cells with ill-defined cytoplasm and variably sized thin and thick walled blood vessels in a myxoid background. Mitotic figures are not seen and no evidence of necrosis is identified. In some areas the tumor shows a fibrous capsule of variable thickness. The excision margin are free of tumor. 

Final diagnosis of right para-testicular mass: Aggressive angiomyxoma.

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