Application of ultrasound in aggressive angiomyxoma: Eight case reports and review of literature

Abstract

Aggressive angiomyxoma (AAM) is a rare tumour that often occurs in soft tissues of the female genital tract. Eight cases of AAM are reported in this article, and the clinical features and ultrasound and magnetic resonance imaging (MRI) results of the eight cases are reviewed and summarized. The main complaints of all the patients were palpable and painless masses in the vulva or scrotum. The lesions were mainly located in the vulva, pelvis, and perineal region, with a large scope of involvement. The sonographic features of AAM were characteristic. On sonography, all of the masses were of irregular shape and showed hypoechogenicity, with a heterogeneous inner echotexture. Intratumoural and peritumoural blood flows were detected by colour Doppler imaging. On real-time ultrasonic imaging, prominent deformation of the lesions was observed by compressing the masses with the probe. Some special imaging features were also revealed, including a laminated or swirled appearance of inner echogenicity, and a finger-like or tongue-like growth pattern. On MRI imaging, the lesions showed intermediate-intensity signals and intermediate to high-intensity signals on TI-weighted and T2-weighted sequences. A rapid and uneven enhancement pattern was demonstrated. After the comparison of sonographic features with MRI and pathological findings, we found the relevance of the ultrasonographic characteristics with MRI and histological features of AAM. Ultrasound can be a valuable imaging method for the preoperative diagnosis, evaluation of scope, and follow-up of AAM.

Keywords: Aggressive angiomyxoma; Case report; Gynaecological neoplasm; Soft tissue neoplasm; Ultrasound.

Figure 1

Pathological results after H-E staining of one case.

Figure 2

Gray-scale ultrasonic images showing irregular hypoechoic masses with internal echogenicity and well-defined margins.

Figure 3

Internal blood flows in the mass detected by colour Doppler ultrasound.

Figure 4

Laminated or swirled appearance of inner echogenicity (blue arrows).

Figure 5

The finger-like growth pattern in the border of the mass could be demonstrated in both cases (blue arrows).

Figure 6

Magnetic resonance imaging images of case 4. A: Intermediate-intensity signals on TI-weighted sequence; B: Intermediate to high-intensity signals on T2-weighted sequence; C: Rapid and uneven enhancement pattern was shown after the injection of contrast agent.