Vaginal cellular angiofibroma

Case contributed by Dr Zainab Sharaf

Presentation

A growing, painless vaginal mass over a 7-week period. Dyspareunia and pressure symptoms.

Patient Data

Age: 45 years
Gender: Female
MRI

The MRI pelvis shows a large solid mass centered 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. 

DSA (angiography)

Angiography performed via a right femoral artery puncture. Selective angiograms showed a single IIA branch supplying the vaginal mass.

This vessel was catheterized with Progreat microcatheter then embolized with 300-500 micrometers of polyvinyl acetate (PVA) particles and one 3/2 micro tornado coil.

The vaginal mass excision procedure was then initiated.

Pathology

Histology report confirming a histological diagnosis of genital angiofibroma.

Case Discussion

Vaginal wall masses are rare lesions, usually arising from the anterior vaginal wall. The differentials range from benign and malignant tumors, urethral diverticulum, cystocele, or skene duct abscess.1

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.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, anesthesiologists, gynecologists and theater team in a dedicated interventional radiology theater, 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. The patient was discharged 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-Gynecologist, Torbay Hospital.

For all their help and support.

 

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Case information

rID: 73580
Published: 15th Jan 2020
Last edited: 16th Jan 2020
System: Gynaecology
Inclusion in quiz mode: Included
Institution: Torbay Hospital

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