Vaginal cellular angiofibroma
Updates to Case Attributes
Vaginal wall masses are rare lesions, usually arising from the anterior vaginal wall. The differentials range from benign and malignant tumours, urethral diverticulum, cystocele, or skene duct abscess (1).1
There are no established guidelines as a result of the low incidence, but the general consensus recommendrecommends excision and histology examination to determine further clinical management.(1).1
Vaginal wall masses are considered a rare entity, along with the unknown histology and nature of the mass, it necessitated a multidisciplinary approach of radiologists, interventionists, anaesthetists, gynaecologists and theatre team in a dedicated interventional radiology theatre, where imaging would roadmap the surgical approach, and the interventionist would reduce intraoperative blood loss. This was achieved through fluoroscopy-guided embolization of the IIA uterine artery branch via an US-guided common femoral artery puncture.
Surgical enucleation of the vaginal mass was conducted with ease, and minimal blood loss. Patient AThe patient was dischargedischarged as a day case. The histology confirmed a benign cellular angiofibroma.
Acknowledgment and many thanks for:
- Dr Peter Kember, Consultant Radiologist, Torbay hospital.
- Mr Manpreet Singh, Consultant Onco-Gynaecologist, Torbay Hospital.
For all their help and support.
-<p>Vaginal wall masses are rare lesions, usually arising from the anterior vaginal wall. The differentials range from benign and malignant tumours, urethral diverticulum, cystocele, or skene duct abscess (1)</p><p>There are no established guidelines as a result of the low incidence, but the general consensus recommend excision and histology examination to determine further clinical management.(1)</p><p>Vaginal wall masses are considered a rare entity, along with the unknown histology and nature of the mass, it necessitated a multidisciplinary approach of radiologists, interventionists, anaesthetists, gynaecologists and theatre team in a dedicated interventional radiology theatre, where imaging would roadmap the surgical approach, and the interventionist would reduce intraoperative blood loss. This was achieved through fluoroscopy-guided embolization of the IIA uterine artery branch via an US-guided common femoral artery puncture.</p><p>Surgical enucleation of the vaginal mass was conducted with ease, and minimal blood loss. Patient A was discharge as a day case. The histology confirmed a benign cellular angiofibroma.</p><p> </p><p>Acknowledgment and many thanks for:</p><p>- Dr Peter Kember, Consultant Radiologist, Torbay hospital.</p><p>- Mr Manpreet Singh, Consultant Onco-Gynaecologist, Torbay Hospital.</p><p>For all their help and support.</p><p> </p>- +<p>Vaginal wall masses are rare lesions, usually arising from the anterior vaginal wall. The differentials range from benign and malignant tumours, urethral diverticulum, cystocele, or skene duct abscess.<sup>1</sup></p><p>There are no established guidelines as a result of the low incidence, but the general consensus recommends excision and histology examination to determine further clinical management<sup>.1</sup></p><p>Vaginal wall masses are considered a rare entity, along with the unknown histology and nature of the mass, it necessitated a multidisciplinary approach of radiologists, interventionists, anaesthetists, gynaecologists and theatre team in a dedicated interventional radiology theatre, where imaging would roadmap the surgical approach, and the interventionist would reduce intraoperative blood loss. This was achieved through fluoroscopy-guided embolization of the IIA uterine artery branch via an US-guided common femoral artery puncture.</p><p>Surgical enucleation of the vaginal mass was conducted with ease, and minimal blood loss. The patient was discharged as a day case. The histology confirmed a benign cellular angiofibroma.</p><p> </p><p>Acknowledgment and many thanks for:</p><p>- Dr Peter Kember, Consultant Radiologist, Torbay hospital.</p><p>- Mr Manpreet Singh, Consultant Onco-Gynaecologist, Torbay Hospital.</p><p>For all their help and support.</p><p> </p>
References changed:
- 1. Bapuraj J, Ojili V, Singh S, Prasad G, Khandelwal N, Suri S. Preoperative Embolization of a Large Vaginal Leiomyoma: Report of a Case and Review of the Literature. Australas Radiol. 2006;50(2):179-82. <a href="https://doi.org/10.1111/j.1440-1673.2006.01550.x">doi:10.1111/j.1440-1673.2006.01550.x</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/16635039">Pubmed</a>
- 1. Preoperative embolization of a large vaginal leiomyoma : case report, Australasiam Radoiology, 2006 https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1440-1673.2006.01550.x
Updates to Study Attributes
The MRI pelvis shows a large solid mass centered incentred on the right side of the vagina, which measures 62 x 60 x 69 mm. It is low signal on T2 with some high signal change centrally which is taken to be fluid. It is low signal on T1, the solid component enhances avidly post contrast. No blood or fat is seen within the mass.It is inseparable from the right pubococcygeus muscle/inferior aspect of the levator ani.
Updates to Study Attributes
AngiograhyAngiography performed via a right femoral artery puncture. Selective angiograms showed a single IIA branch supplying the vaginal mass.
This vessel was cathetarisedcatheterised with Progreat microcatheter then embolised with 300-500 micrometersmicrometres of polyvinyl acetate (PVA) particles and one 3/2 microtornadomicro tornado coil.
The vaginal mass excision procedure was then initiated.
Updates to Study Attributes
Histology report confirming a histological diagnosis of genital angiofibroma.