Int J Intg Med Sci 2016;3(7):328-31. ISSN 2394 - 4137 328

Case Report

A Large Inguinal Angiofibroma: A Rare EntityDevendra K. Prajapati *1, Kapil Rampal 1, Jyoti M Prajapati 2.*1 Senior Resident Department of Surgery, Deendayal Upadhyay Hospital, New Delhi, India.2 Scholar in Computer Application.

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ABSTRACT

INTRODUCTION

Address for correspondence: Dr. Devendra K Prajapati, WZ 423 A Nanakpura Harinagar, NewDelhi-110064, India. E-Mail: dr.dev1982@gmail.com

International Journal of Integrative Medical Sciences,Int J Intg Med Sci 2016, Vol 3(7):328-31. ISSN 2394 - 4137

DOI: http://dx.doi.org/10.16965/ijims.2016.128

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Received: 07-06-2016 Reviewed: 07-06-2016

Accepted: 20-06-2016Published: 31-07-2016

Source of Funding: Self Conflicts of interest: NoneDOI: 10.16965/ijims.2016.128

Angiofibroma of the groin is a rare soft tissue benign tumour. Here we emphasize upon itsdiagnosis and management with a follow up in post-operative period. Microscopic demonstrationof well circumscribed spindle cells and hyalinised vessels along with immunohistochemistryhelps in clinching a diagnosis.KEY WORDS: Angiofibroma, Inguinal Swellings, Soft Tissue Tumours, Immunohistochemistry.

Nucci et al. in 1997 first mentioned aboutcellular angiofibroma as a rare benign soft tissuetumor [1]. This soft tissue tumor usually foundin the distal genital tract of either sex like:inguino-scrotal area in male and vulvo-vaginalregion in females [1,2], this tumor has nomorphological differences in either genderaccording WHO classification [3].Grossly these tumors are well circumscribed,reside in the superficial soft tissue and contain:spindle cells and small to medium-sized vesselswith mural hyalinization [4].

CASE REPORT

A 65 year female attended surgery OPD withcomplains of painless, gradually progressiveswelling over the right groin area for one year. Itwas gradually increased in size and attainedpresent size after a year. No history of fever,pain, weight loss or other sign of chronic illness.

Fig. 1: Showing deep extension of swelling.

On clinical examination- patient’s generalcondition was good. There was no pallor, icterus,cyanosis, clubbing, or generalised lymphadeno-pathy.All systems were WNL.Local examination- 22 cm X 8 cm sized welldefined spherical right inguinal swelling, with asmooth surface. There were no signs suggestiveof inflammation. Cough impulse absent, theswelling was non-reducible and non-compressible.

Int J Intg Med Sci 2016;3(7):328-31. ISSN 2394 - 4137 329

Devendra K. Prajapati, Kapil Rampal, Jyoti M Prajapati. A Large Inguinal Angiofibroma: A Rare Entity.

Overlying skin had no scar or dilated veins.All routine investigations performed which wereperfectly in normal range.Radiologically- USG with color Dopplersuggested a well-defined heterogenous hypoe-choic space occupying lesion in right thigh andgroin region in the subcutaneous plane, whichshowed vascular arterial and venouscomponents suggestive of arteriovenousmalformation.CT angiography right lower limb showed a largeenhancing mass lesion in the subcutaneousplane in right upper thigh inguinal region. Nounderlying muscle invasion and major arterialsupply or venous drainage were seen.FNAC suggestive of blood mixed aspirate show-ing some fibrous stromal fragments, somemixoid appearing matrix with embedded spindlecells. Suggestive of ?? Hamartoma, Firm myxoidtumor.Finally, patient planned for excision and biopsyand under anaesthesia complete excision ofswelling with capsule done. Swelling was foundto be confined to the subcutaneous plane withtail extending into deep plane and simulating ahernia. Primary closure of wound was followedby an uneventful postoperative period. Sutureremoved on day eighth post-operative day inOPD. Intra operative findings are depicted inFigures 1 to 5.After a great deal of dilemma, the lesion finallylabelled as an “angiofibroma” on the basishistopathological report Fig 6, 7.Report shows well defined spindle cell tumorwith uniform stromal cells and hyalinisedvessels.

Fig. 2: Showing subcutaneus location swelling.

Fig. 3: Showing deep extension.

The patient on his six monthly follow up wasfound to be doing good with no loco-regionalrecurrence of swelling.

Fig. 4: Showing excised out lesion.

Fig. 5: Showing wound after excision.

Fig. 6: Showing hylinizton of vessels spindle cells.

Int J Intg Med Sci 2016;3(7):328-31. ISSN 2394 - 4137 330

Devendra K. Prajapati, Kapil Rampal, Jyoti M Prajapati. A Large Inguinal Angiofibroma: A Rare Entity.

Fig. 7: Showing stromal cells and hyalinization of vessels.

DISCUSSION

Cellular angiofibroma is a rare soft tissue tumorwith equal prevalence in both genders, but amore preponderance is seen towards fifthdecade of females and seventh decade of males[5].Commonest site for cellular angiofibroma issubcutaneous tissue of the vulva in women andin inguinal and scrotal regions of men [6].However,some angiofibromas also reported insubcutaneous tissue chest wall, retroper-itoneum and the oral cavity [6-8].Microscopically, cellular angiofibroma is a wellcircumscribed spindle cell tumor consisting ofuniform stromal cells and hyalinised vessels,therefore the name angiofibroma was suggestedon the basis of predominant blood vessels andthe uniform stromal cells [1].Cellular angiofibroma sometimes may associat-ed with cellular atypia or sarcomatoustransformation morphology [9]. These casesonly require local excision with clear marginsand long-term follow-up [5,6].Angiofibroma is well encapsulated andhypervascular tumor where surgical excision ofthe lump along with its capsule prevent itsrecurrence, with minimal blood loss [5].Clinical demonstration of cellular angiofibromamay simulate many benign tumors likeleiomyoma, angiomyofibroblastoma, spindle celllymphoma and perineurioma [1, 11] for there aremany common features between these tumors,but cellular angiofibroma differentiated withothers by distinguishing feature of bland spindlecells and prominent hyalinized blood vessels inbiopsy [1, 10, 11].

CONCLUSION

Moreover, immunohistochemistry plays asubstantial role in differentiating from thesetumors as Cellular angiofibromas areconsistently positive for vimentin with variableexpression of CD34 and desmin, and negativefor smooth muscle actin (SMA) and S-100 [10,12].Our case was a well-defined swelling in rightgroin region that simulated all above mentionedbenign tumour along with inguinal and femoralhernia. These were ruled out on the basis ofclinical findings and radiological investigations.Lesion was managed by complete excision andfollow up. Final diagnosis of cellularangiofibroma was confirmed on the basis ofhistopathological findings.

REFERENCES

Angiofibroma as a differential diagnosis of in-guinal swelling is rare finding compared to themore prevalent conditions as hernias or lymphnode masses. However a watchful examinationwith adequate use of radiological and pathologi-cal investigations is recommended.

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Int J Intg Med Sci 2016;3(7):328-31. ISSN 2394 - 4137 331

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How to cite this article:Devendra K. Prajapati, Kapil Rampal, Jyoti M Prajapati. A Large InguinalAngiofibroma: A Rare Entity. Int J Intg Med Sci 2016;3(7):328-331. DOI:10.16965/ijims.2016.128