Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2018; 6(14): 811-819
Published online Nov 26, 2018. doi: 10.12998/wjcc.v6.i14.811
Application of ultrasound in aggressive angiomyxoma: Eight case reports and review of literature
Chen-Yang Zhao, Na Su, Yu-Xin Jiang, Meng Yang
Chen-Yang Zhao, Na Su, Yu-Xin Jiang, Meng Yang, Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
Author contributions: Zhao CY and Su N contributed equally to this work; Yang M, Su N and Zhao CY designed the study; Su N and Yang M provided the imaging data of the cases; Zhao CY, Su N and Yang M searched the literature and analyzed the data; Zhao CY wrote the paper; and Yang M, Su N and Jiang YX edited the paper.
Supported by the International S and T Cooperation Program of China, No. 2015DFA30440; the National Natural Science Foundation of China, No. 81301268; Beijing Nova Plan, No. xxjc201812 and No. Z131107000413063.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest.
CARE Checklist (2016) statement: This manuscript was prepared following the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Meng Yang, MD, Chief Doctor, Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, No. 1, Shuaifuyuan, Dongcheng District, Beijing 100730, China. yangmeng@pumch.cn
Telephone: +86-10-69155494 Fax: +86-10-69155494
Received: August 23, 2018
Peer-review started: August 23, 2018
First decision: October 4, 2018
Revised: October 16, 2018
Accepted: October 23, 2018
Article in press: October 22, 2018
Published online: November 26, 2018
Processing time: 95 Days and 22.4 Hours
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; Ultrasound; Soft tissue neoplasm; Case report; Gynaecological neoplasm

Core tip: Eight cases of aggressive angiomyxoma (AAM) were collected in this manuscript. The lesions of AAM appear as irregular hypoechoic masses with internal echogenicity and well-defined borders on ultrasonic imaging. Some special imaging features of AAM, such as laminated or swirled sign and finger-like growth pattern, can also be seen on ultrasound examination. The abundant intratumoral blood flows on colour Doppler ultrasound is a distinctive feature of AAM, which can be a crucial clue for the diagnosis. These ultrasonic features of AAM correlate with the findings of magnetic resonance imaging and histology. Ultrasound can be utilized in the preoperative diagnosis and follow-up of AAM.