General
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• Benign edematous tumor of perineum and external genitalia (Stanford University)

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 features
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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
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• Well-circumscribed, tan to rubbery cut surface and somewhat edematous appearance
• Mean tumor size 7 cm

Gross images
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9 cm scrotal mass

Gelatinous tumor

Testis

Micro description
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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 and 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

Various images

Spermatic cord

Inguinal tumor

Testis

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 and 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

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