Kamineni Institute of Medical Sciences, Sreepuram, Narketpally, Nalgonda; Andhra Pradesh-508254, India

A uncommon tumour called cellular angiofibroma of the vulva was first identified in 1997. It has well-circumscribed edges, is small (less than three centimetres in diameter), and only affects middle-aged women (average age: 47 years). We describe a rare case of vaginal angiofibroma in a 20-year-old pregnant woman from South India that manifested as an antepartum haemorrhage at 34 weeks of gestation. Aggressive angiomyxoma, angiomyofibroblastoma, lipoma with fusiform cells, solitary fibrous tumour, perineurioma, and leiomyoma are among the possible differential diagnosis for this tumour.

Key words: Vagina, Neoplasm, Angiofibroma, Pregnancy

Vaginal angiofibroma is an uncommon harmless cancer of the regenerative age however ought to be considered as an interesting differential conclusion of antepartum discharge when it gets tainted or following sex.Angiomyofibroblastoma is a delicate tissue cancer that happens principally, yet not solely, in the vulval district of premenopausal ladies [1]. Cell angiofibroma is an intriguing growth portrayed interestingly by Nucci et al. in 1997 [2]. It comprises of a tumoural mass of little size that is by and large very much surrounded, and it commonly emerges in moderately aged patients. The differential analyses for this neoplasia incorporate forceful angiomyxoma, angiomyofibroblas­toma, lipoma of fusiform cells, sinewy growths, perineurioma and leiomyoma. This differentia­tion is finished through the histological and im­munohistochemical qualities. We report a case emerging in the vagina during pregnancy to draw the consideration of pathologists and obstetricians to the way that this uncommon neoplasm can happen outside the vulva.

A long term south Indian primigravida with 34 weeks of growth answered to the crisis pregnancy evaluation unit with grumblings of agony in the lower mid-region and low spinal pain since one day span. She gives history of mass per vagina since two months length. She gives history of vaginal draining since two days. The draining was moderate in sum. There was no set of experiences of loose bowels, fever, urinary grievances or any new ailment. She was hitched beginning around nine months. Her periods were normal. She imagined suddenly. She had normal antenatal exams. Her first and second trimesters were routine. No huge past clinical and careful history noted.

On assessment, patient was cognizant, intelligible with heartbeat 108/min, pulse 110/80 mmHg, temperature typical, cardiovascular and respiratory frameworks ordinary. Stomach assessment uncovered fundal level comparing to 34 weeks incubation. Uterus was peevish and tense. There was a solitary hatchling in longitudinal lie with vertex show. Fetal pulse was great and ordinary. On vaginal assessment, an oedematous delicate development of 5 × 4 cm was seen at the introitus which was not reducible. The mass was draining on touch. A differential conclusion of cervical contaminated pedunculated myoma, vaginal development, placental unexpectedness and cervical prolapse were made.

Her blood examinations were typical with the exception of a raised complete leucocyte count of 16.5 × 109/L. Pee assessment showed 5 - 6 discharge cells and ensuing society uncovered no development. Non stress test was receptive.

Ultrasound filter showed a solitary live intrauterine hatchling in cephalic show of 33 weeks development with assessed fetal load of 2208 g. Placenta was front upper section with grade II development without really any proof of retroplacental cluster. Liqour was satisfactory. An isoechoic mass of 5 × 4 cm was seen emerging from the parallel vaginal wall with expanded vacularity on Doppler was seen. She was given two portions of steroid for fetal lung development. She was on finished bed rest with foot end height and vulval cushion was kept absorbed saline. The vaginal mass diminished in size to 3 × 4 cm. Her pregnancy went on till term and she conveyed an alive female child of birth weight 2.7 kg by cesarean segment. The vaginal mass was seen emerging from the upper right vaginal mass of 3 × 4 cm. Complete extraction of the development was finished and sent for histopathological assessment. Histopathological assessment showed angiofibroma of vagina.

Shallow vaginal angiomyofibroblastoma can be confused with a forceful angiomyxoma, cell angiofibroma and endometrial stromal sarcoma. Shallow myofibroblastoma of the lower female genital parcel presumably has a place with the morphological range of vulvovaginal stromal polyps. Variegated designs are depicted including myxoid, ribbon like, strainer like, fascicular, or storiform [3, 4]. The histomorphological highlights one of a kind to this cancer are its shallow subepithelial area, great margination, and multipatterned development of uniform, spindled and stellate molded cells, fluctuating measured veins and profoundly collagenous and centrally myxoid stroma. The immunohistochemical study showed energy just for vimentin, which recommends, as per the writing, that the cancer cells are of fibroblastic origin.

The sore generally presents as a polypoidal or nodular mass in the cervix or the vagina normally in the fifth to eighth ten years dissimilar to for our situation it introduced in the early second ten years [5].Our patient gave a mass external the vagina which was draining and haemorrrhagic and she had elements of hyperdynamic course like tachycardia which made us think as an instance of suddenness placenta or a contaminated cervical polyp or prolapse which was not reducible. On additional work up with ultrasound output and Doppler we felt that it was a vaginal development/polyp and afterward we focused on continuation of pregnancy once the intense episode of draining halted. With the histopathology we could show up at a determination of angiofibroma. The growth has a very generally safe of repeat if totally extracted [6]. We followed our case for a very long time prior to revealing.

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Satyanarayana Veeragandham. A Case Report of Vaginal Angiofibroma During Pregnancy Presenting as Antepartum Hemorrhage. Insights Journal of Obstetrics And Gynecology 2022.