Location
Moultrie, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
Introduction
Angiomyofibroblastoma (AMFB) is a rare benign mesenchymal tumor of the lower female genital tract that predominantly affects women of reproductive age. AMFB, which was initially identified by Fletcher et al. in 1992, often develops in the vulva, however it has also been documented in the vagina and perineum. Clinically, it usually manifests as a tiny (less than 5 cm), well-circumscribed, slow-growing, painless vulvar mass. It is commonly misinterpreted as a benign labial lesion, such as a cyst of the Bartholin gland. Histologically, AMFB shows a distinct growth of bland spindle to epithelioid stromal cells encircling numerous thin-walled blood vessels in alternating hypocellular and hypercellular edematous stroma. Desmin, vimentin, estrogen receptor (ER), and progesterone receptor (PR) are frequently expressed by tumor cells in immunohistochemistry, indicating hormonally responsive stromal differentiation. Since aggressive angiomyxoma (AA) has infiltrative growth and recurrence rates of 25–47%, which often require larger excision and extended surveillance, accurate differentiation from AA is crucial. On the other hand, local excision is usually sufficient to treat AMFB.
Methods
A 31-year-old gravida 1 para 1 woman with otherwise uncomplicated prenatal care reported a painless right labial cyst at 34.4 weeks gestation. No acute intervention was performed antenatally. At 38.3 weeks, she was admitted in labor, augmented with Cook balloon and oxytocin, and received epidural anesthesia. She delivered a viable female infant in left occiput anterior presentation with Apgar scores of 9 at 1 and 5 minutes. During the documented vaginal delivery procedure, the right labial cyst was excised via scalpel incision and blunt dissection with reapproximation of the labial tissue using absorbable sutures. Bilateral labial lacerations and a second-degree perineal laceration were repaired. The specimen was submitted for histopathologic analysis.
Results
A 3.0 × 1.8 × 1.0 cm well-circumscribed pink-tan soft tissue lesion was excised from the right labia. Gross examination revealed a solid, firm lesion without cystic spaces, mucinous components, hemorrhage, or necrosis. Histopathologic evaluation was consistent with angiomyofibroblastoma. The lesion was completely excised in the examined tissue planes. Five days postpartum, the patient presented to the emergency department with passage of a blood clot and mild abdominal discomfort. She remained hemodynamically stable. A postpartum pelvic ultrasound showed an enlarged uterus with homogeneous myometrium and endometrial thickness; no retained products of conception were identified. Laboratory evaluation revealed mild anemia and urinalysis findings consistent with acute cystitis. She was treated with oral antibiotics and discharged home without the need for surgical re-intervention. There was no evidence that the bleeding was related to the cystectomy site.
Conclusion
Angiomyofibroblastoma is a rare benign vulvar tumor that may clinically mimic common labial cysts encountered during obstetric care. This case highlights the importance of routine histopathologic evaluation of excised vulvar lesions and careful differentiation from aggressive angiomyxoma to guide appropriate management. Complete local excision remains curative with excellent prognosis and low recurrence risk. Recognition of this entity in community hospital settings reinforces the value of multidisciplinary collaboration in ensuring accurate diagnosis and optimal maternal outcomes.
Embargo Period
5-28-2026
Included in
Vulvar angiomyofibroblastoma: a rare tumor excised during vaginal delivery
Moultrie, GA
Introduction
Angiomyofibroblastoma (AMFB) is a rare benign mesenchymal tumor of the lower female genital tract that predominantly affects women of reproductive age. AMFB, which was initially identified by Fletcher et al. in 1992, often develops in the vulva, however it has also been documented in the vagina and perineum. Clinically, it usually manifests as a tiny (less than 5 cm), well-circumscribed, slow-growing, painless vulvar mass. It is commonly misinterpreted as a benign labial lesion, such as a cyst of the Bartholin gland. Histologically, AMFB shows a distinct growth of bland spindle to epithelioid stromal cells encircling numerous thin-walled blood vessels in alternating hypocellular and hypercellular edematous stroma. Desmin, vimentin, estrogen receptor (ER), and progesterone receptor (PR) are frequently expressed by tumor cells in immunohistochemistry, indicating hormonally responsive stromal differentiation. Since aggressive angiomyxoma (AA) has infiltrative growth and recurrence rates of 25–47%, which often require larger excision and extended surveillance, accurate differentiation from AA is crucial. On the other hand, local excision is usually sufficient to treat AMFB.
Methods
A 31-year-old gravida 1 para 1 woman with otherwise uncomplicated prenatal care reported a painless right labial cyst at 34.4 weeks gestation. No acute intervention was performed antenatally. At 38.3 weeks, she was admitted in labor, augmented with Cook balloon and oxytocin, and received epidural anesthesia. She delivered a viable female infant in left occiput anterior presentation with Apgar scores of 9 at 1 and 5 minutes. During the documented vaginal delivery procedure, the right labial cyst was excised via scalpel incision and blunt dissection with reapproximation of the labial tissue using absorbable sutures. Bilateral labial lacerations and a second-degree perineal laceration were repaired. The specimen was submitted for histopathologic analysis.
Results
A 3.0 × 1.8 × 1.0 cm well-circumscribed pink-tan soft tissue lesion was excised from the right labia. Gross examination revealed a solid, firm lesion without cystic spaces, mucinous components, hemorrhage, or necrosis. Histopathologic evaluation was consistent with angiomyofibroblastoma. The lesion was completely excised in the examined tissue planes. Five days postpartum, the patient presented to the emergency department with passage of a blood clot and mild abdominal discomfort. She remained hemodynamically stable. A postpartum pelvic ultrasound showed an enlarged uterus with homogeneous myometrium and endometrial thickness; no retained products of conception were identified. Laboratory evaluation revealed mild anemia and urinalysis findings consistent with acute cystitis. She was treated with oral antibiotics and discharged home without the need for surgical re-intervention. There was no evidence that the bleeding was related to the cystectomy site.
Conclusion
Angiomyofibroblastoma is a rare benign vulvar tumor that may clinically mimic common labial cysts encountered during obstetric care. This case highlights the importance of routine histopathologic evaluation of excised vulvar lesions and careful differentiation from aggressive angiomyxoma to guide appropriate management. Complete local excision remains curative with excellent prognosis and low recurrence risk. Recognition of this entity in community hospital settings reinforces the value of multidisciplinary collaboration in ensuring accurate diagnosis and optimal maternal outcomes.