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aggressive angiomyxoma
Tuesday 7 February 2006
AAMs, ’aggressive’ angiomyxoma; deep aggressive angiomyxoma
Definition: Aggressive angiomyxoma (AA) is a distinctive, locally aggressive, fibromyxoid tumor of the pelvic and genital soft tissues.
Digital case
JRC:1443 : Aggresive angiomyxoma of pelvic soft tissues.
JRC:14570 : Aggresive angiomyxoma of peritoneum (ischiorectal fossa).
Images
Deep (agressive) angiomyxoma. Young women vulvar tumor
- https://twitter.com/luishcruzc/status/758685476341415936
- https://twitter.com/UMichPath/status/1149362467828404224
AA is of unknown histogenesis but the cytologically bland spindled tumor cells, which surround characteristic variegated blood vessels, show fibroblastic or myofibroblastic features.
AA may be related to angiomyofibroblastoma (AMF), another cytologically bland fibromyxoid genital spindle cell tumor with variable myoid differentiation that does not, as a rule, recur.
The lesion formerly known as ’aggressive angiomyxoma’, which shows a predilection for the pelviperineal region of women, has been redesignated as deep ’aggressive’ angiomyxoma in order to de-emphasize the perception of aggression.
It is now appreciated that no more than 30% of these lesions recur locally and the majority of such recurrences are cured by one further re-excision.
Original perceptions concerning the more aggressive nature of this tumour type were likely to have been influenced by the inevitably skewed nature of consultation material.
Synopsis
tumoral cells: wavy and fibrillar, spindled, stellate
polygonal fibroblast-like CD34+ dendritic cells
+/- nuclear and cytoplasmic staining for FXIIIa
Differential diagnosis
angiomyofibroblastoma (AMF)
- AA and AMF are myxoid fibrohistiocytic tumors composed of CD34+ fibroblasts.
- Neoplastic CD34+ dendritic fibroblasts showed predominantly myxo-collagenous differentiation.
- Both AMF and AA are part of a morphologic and histogenetic continuum of myxofibrous and myoid tumors that may arise due to interactions between microvascular CD34+ fibroblasts and FXIIIa+ histiocytes.
Localization
vulva, vagina (vulvovaginal aggressive angiomyxoma)
pelvis soft tissues (aggresive angiomyxoma of pelvic soft tissues)
hypodermis (hypodermal aggressive angiomyxoma)
larynx (laryngeal aggressive angiomyxoma) (8868184)
Cytogenetics
12q13-15 rearrangement with HMGA2 rearrangement and abnormal expression in aggressive angiomyxoma
- t(8;12) (11550285) : HMGA2 rearrangements
- t(1;12)(p32;q15) (17654722)
- t(12;21)(q15;q21.1) (18295664)
Molecular biology
HMGA2 rearrangements in 33% of AAMs (17654722)
See also
CD34+ primitive fibroblasts
factor XIIIa+ dendritic histiocytes
fibrovascular tumors
fibrohistiocytic tumors
myxoid soft tissue tumors
microvascular unit (tissue responsible for stromal repair and remodeling and angiogenesis)
CD34+ fibroblasts
FXIIIa+ histiocytes (FXIIIa+ dendritic cells or FXIIIa+ dendritic histiocytes)
See also
angiomyxomas
- superfical angiomyxoma (cutaneous myxoma)
- deep angiomyxoma
See also
References
Rawlinson NJ, West WW, Nelson M, Bridge JA. Aggressive angiomyxoma with t(12;21) and HMGA2 rearrangement: report of a case and review of the literature. Cancer Genet Cytogenet. 2008 Mar;181(2):119-24. PMID: 18295664
The evolving classification of soft tissue tumours: an update based on the new WHO classification. Fletcher CD. Histopathology. 2006 Jan;48(1):3-12. PMID: 16359532