Presentation
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
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.
In addition, note is made of Nabothian cysts and a small amount of pelvic free fluid.
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