Angiomyofibroblastoma mimicking an inguinal hernia: a challenging diagnosis in a male patient

Abstract

Introduction: Angiomyofibroblastoma is a rare benign myofibroblastic neoplasm which mainly occurs in the soft tissues of the pelvi-perineal region of females.

Aim: To present an unusual case of angiomyofibroblastoma mimicking an inguinal hernia in a 62-year-old male.

Material and methods: The patient was hospitalized with an irreducible, painless inguinal mass and surgical intervention for inguinal hernia was decided. The well-defined nodular mass was sent for histological examination.

Results: Under microscope, proliferation of spindle and oval cells around thin-walled vessels was observed, being intermingled with mature adipocytes. We did not identify necrosis, haemorrhage, cytologic atypia or mitotic figures. The tumour cells displayed positivity for desmin, vimentin, CD34, oestrogen and progesterone receptors, a low Ki67 index and unusual nuclear positivity for c-theta (PKCθ). They were negative for smooth muscle actin (SMA), S100, CD44, maspin, synaptophysin, DOG1 and CD117. The case was diagnosed as angiomyofibroblastoma, the main challenge being the differential diagnosis with aggressive angiomyxoma, which can present a similar histologic aspect and immunophenotype and recurs more frequently. No recurrences were observed 8 months after the surgery.

Conclusions: Angiomyofibroblastoma should be included in the differential diagnosis of inguinal hernia. This is the fourteenth case of angiomyofibroblastoma diagnosed in males.

Keywords: CD44; angiomyofibroblastoma; c-theta; inguinal mass; maspin.

Figure 1

The angiomyofibroblastoma presented in the inguinal region of a male patient is displayed as an encapsulated solid mass with a tan colour cut surface (A). Microscopically, the well-circumscribed tumour (B) consists on small groups of round, oval-shaped and elongated cells with clear, vacuolated or eosinophilic cytoplasm and pleomorphic hyperchromatic nuclei with no nucleoli (C). The tumour cells are positive for desmin (D), CD34 (E) and oestrogen-receptor (F) and display unusual PKCθ nuclear positivity (G)