Preoperative diagnosis of AMFB and distinction from other soft tissue tumors is often difficult, as there is limited information on characteristic imaging findings.
Although AMFB is a rare diagnosis, it is an important consideration in the premenopausal and perimenopausal patient presenting with a vulvovaginal mass given its predilection for this region of the female genital tract.
Differential diagnosis for AMFB includes Gartner's duct cyst, epidermal inclusion cyst, leiomyoma, and fibroepithelial polyps among the more common etiologies.
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To establish the diagnosis of the male AMFB in our case, a variety of benign and malignant myxoid soft-tissue neoplasms needed to be ruled out.
The histologic features of AMFB vary considerably among the cases characterized by alternative hypocellular and hypercellular areas, showing considerable variation in cellular morphology and displaying spindle, satellite, oval or epithelioid cells, and occasional polymorphic cells, as shown in the present case.
However, much controversy exists among recent reports regarding the immunophenotypes of AMFB and AAM.[6,8-10] Most notably, AMFB has been known to display a variable combination of the differential markers, among which they are frequently positive for vimentin and desmin but not for smooth muscle actin.
AMFB is a very rare benign, mesenchymal tumour with less than 100 cases previously having been reported in the literature.
AMFB is morphologically similar to other invasive mesenchymal cell tumours such as aggressive angiomyxoma (AAM) and cellular angiofibroma and they share many overlapping immunohistochemical and structural features [9,10].
It is diagnostically challenging to differentiate between AMFB and AAM but important due to the latter's locally invasive nature, the possibility of metastasis, and the high risk of local recurrence [11,12].