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Penis and scrotum
Neoplastic lesions of scrotum
Angiomyofibroblastoma
Editors: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (see Author/Reviewers page)
Revised: 22 May 2010, last major update May 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Benign edematous tumor of perineum and external genitalia
Terminology
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● Also called male angiomyofibroblastoma-like tumor, cellular angiofibroma
Epidemiology
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● Median age 57 years (range 39 to 88 years)
Sites
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● Scrotum or inguinal region
Clinical
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● Features of vulvovaginal angiomyofibroblastoma and spindle cell lipoma (Am J Surg Pathol 1998;22:6)
● May overlap with cellular angiofibroma
● Low tendency for recurrence
Case reports
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● 27 year old man with inguinal tumor (Arch Pathol Lab Med 2000;124:1679)
Treatment
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● Simple excision
Gross description (Macroscopy)
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● Well-circumscribed, tan to rubbery cut surface, somewhat edematous appearance
● Mean tumor size 7 cm
Gross images
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9 cm scrotal mass Gelatinous tumor
Testis: lobulated, well circumscribed red-tan mass
(AFIP image courtesy of Dr. W. Laskin, Chicago)
Micro description (Histopathology)
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● Hypercellular areas of spindle, plump or oval stromal cells that alternate with hypocellular areas containing similar cells loosely dispersed in an edematous background
● Hypercellular areas tend to be located around vascular spaces
● Thin-walled blood vessels are easily found throughout the tumor with mild perivascular hyalinization common
● Mast cells are readily identified, sometimes in abundance
● May have bizarre degenerative and multinucleated neoplastic cells, focal epithelioid stromal cells, clusters of mature adipocytes
● Low mitotic rate
● No stromal mucin (stroma is NOT myxoid but edematous to collagenous)
Micro images
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49 year old man with 9 cm scrotal mass - University of Oklahoma
Various images
Spermatic cord
Testis: note the prominent vascularity and cellular intervening stroma
AFIP image courtesy of Dr. J. Fetsch, Washington, D.C.
Inguinal tumor
Virtual slides
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Angiomyofibroblastoma-like tumor of scrotum
Positive stains
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● Vimentin, desmin; variable ER, PR (Ann Pathol 2005;25:58)
●
Often CD34
Negative stains
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● Cytokeratin, S100, muscle specific actin, alpha smooth muscle actin
Differential Diagnosis
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● Aggressive angiomyxoma: larger tumor size, tendency to deeper location, infiltrative growth, prominent hyalinization/hypertrophy of vascular walls, no perivascular accentuation of stromal cells, neoplastic cells are more spindled / stellate, desmin negative, variable muscle specific actin / alpha smooth muscle actin
● Myxoid leiomyoma: more cellular, lacks prominent vascularity, muscle specific actin positive
● Superficial angiomyxoma: multinodular growth, abundant stromal mucin, low cellularity, no perivascular accentuation of stromal cells
● Peripheral nerve sheath tumors: spindle cells with wavy nuclei, no prominent vascularity
Additional references
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End of Penis and scrotum > Neoplastic lesions of scrotum > Angiomyofibroblastoma
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