Case contributed by Cedric Bohyn
Diagnosis almost certain


Painless palpable nodular growth in the perianal region. The patient reported it to grow to the size of a grape in one year. No other symptoms whatsoever.

Patient Data

Age: 30 years
Gender: Female

Left-sided perineal tumoral mass (6.3 AP x 5.2 LL x 18 cm CC) with cranial extension lateral to the left levator ani muscle in the ischioanal fossa through the levator plate to the supralevator region to the left parauterine/ovarian level. No evidence of invasion of other pelvic organs but there appears to be invasion of the external sphincter (1-3 o'clock). The lesion causes significant mass effect with a right-sided deviation of the pelvic organs (bladder, uterus, vagina, and rectum). The mass has a laminated/tubular, mainly T2-hyperintense appearance. DWI (B1000) shows a hyperintense signal with heterogenous mild increased ADC values. The late (10 min.) post-contrast sequence shows general persistent contrast enhancement and some areas of washout.

No enlarged lymph nodes are present.

Case Discussion

The lesion shows all of the characteristic findings of an angiomyxoma:

  • young female
  • extension in both the pelvic and perineal compartments
  • no obvious malignant tumoral characteristics 
  • 'swirled or laminated' internal appearance

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