aggressive angiomyxoma was first reported as a distinct variant of myxoid neoplasms in the female vagina and pelvis by steeper and rosai .
these tumors mostly occurs in 3 to 5 decade of life and 95% in females .
these lesions have a predilection for female pelvic soft parts , slow growth , frequent recurrences , and are characterized histologically by a predominantly myxoid stroma and an abundance of thin and thick walled vascular channels .
this is a deep soft tissue tumor , which as the name suggests , may have a locally aggressive course .
most tumors occur in women and are large , usually greater than 10 cm , slowly growing , and painless .
the most common location is in the perineal region and may exert pressure on adjacent organs .
no .  a 8332 came to our opd on 05.08.05 with chief complaints of growth in the vulva - 2 month , bleeding from the growth - 1 month , irregular period - 6 month .
no history of htn , dm , tb . tubectomy was done a year ago . on examination , gc is fair , pallor + , no palpable ln .
no organomegaly , others nad , groin- nad . local examination of the vulva revealed a 8  5 cms pedunculated growth [ figure 1 ] having its thick pedicle of about 1.5 cm thickness hanging from the clitoreal region slightly on the left side [ figure 2 ] .
p / r- nad . clinical presentation growth coming out from the clitoreal region on investigation , hb % - 9.8 gm% , abo gr.- o + ve , rbs- 101 mg / dl , rft - wnl , lft - wnl .
pap smear - nad , cxr - nad , usg ( w / a )  nad .
she was planned for wide excision of the vulval growth ; accordingly it was done under sa on 18.08.05 [ figure 3 ] .
on sectioning , the mass had focally infiltrating margins and a rubbery glistening grey / white surface [ figure 4 ] .
post op hpe revealed aggressive angiomyxoma [ figures 5 and 6 ] , cut margins negative .
ihc studies revealed desmin and vimentin + ve , er , pr + ve and s100 protein negative .
she is under regular follow - up , and doing well for the last 5 years .
hpe shows thin epidermis and underlying hypo cellular myxoid tissue containing blood vessels of various calibers high power view showing hyaline thickening of blood vessels
aggressive angiomyxoma is a rare , benign neoplasm that can be mistaken both clinically and on microscopy for several other conditions , it should be included as a differential diagnosis for any vaginal mass .
it is important to diagnose this condition because the tumour is locally infiltrative and requires wide excision and follow up .
it occurs mainly in the female pelvis , vulva , or perineum , though some cases are described in men .
some authors believe that it is the only possible treatment , but surgery is often radical and can be mutilating , with massive blood loss .
it also requires postoperative intensive care monitoring , and the recurrence rate after surgery remains high even if negative margins are obtained at the initial resection .
a retrospective review has shown that patients having positive margins were as likely to have recurrence as those with negative margins .
immunohistochemistry of the tumor cells revealed diffuse immunoreactivity for estrogen receptors , progesterone receptors , vimentin , and cd34 .
no expression of s-100 protein , bcl-2 protein , cd117 ( c - kit gene product ) , epithelial membrane antigen , desmin , or h - caldesmon could be demonstrated .
 aggressive angiomyxoma is a rare , benign neoplasm occurring in 3rd to 5th decade of life that can be mistaken both clinically and on microscopy for several other conditions , it should be included as a differential diagnosis for any vaginal mass . 
 these lesions have a predilection for female pelvic soft tissues , slow in growth , and are characterized histologically by a predominantly myxoid stroma and an abundance of thin and thick walled vascular channels . 
 this is a deep soft tissue tumor , which as the name suggests , may have a locally aggressive course . 
 most tumors occur in women and are large , usually greater than 10 cm , slowly growing , and painless . 
 standard of care treatment for angiomyxoma has been surgery . 
 some authors believe that it is the only possible treatment , but surgery is often radical and can be mutilating , with massive blood loss . 
INTRODUCTION
CASE REPORT
DISCUSSION