¹奇美醫學中心 外科部 泌尿科

Chye-Yang Lim¹, Alex Chien-Hwa Liao¹, Kun-Hung Shen¹

¹Divisions of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan

 

This is a 53 years old male without significant chronic disease before. A left inguinal mass incidentally found by abdominal CT when survey for the urolithiasis at emergency department. Tracking back to the history of patient, he ever underwent left herniorrhaphy (Bassini's method) for mixed type inguinal hernia about 4 years ago. A fatty tissue resected during operation which revealed as lipoma by pathologist. Then, he found a mass getting growth at the operation site of left inguinal area. As there was no significant symptoms, he left it unnoticed. After management of the right ureteral stone by ureterorenoscopic stone manipulation, a series of examination done for the mass. The mass was solitary, non-movable, non-tender with intact previous OP scar at left inguinal area. The both testes were in anatomical location with normal size. Tumor markers for testicular cancer showed within normal limits. Meanwhile further ultrasonography done which disclosed a left inguinal mass about 7.5cm in size without obvious internal vascularity and no inguinal hernia found. To make clarification for the nature of the mass, the patient agreed to undergo excision. During operation, the mass noted located subcutaneously above the aponeurosis of external oblique muscle. The mass rubbery in sensation and mixed yellowish with reddish color internally. The final pathology disclosed cellular angiofibroma. There was uneventful postoperatively and he was discharged on POD 1.

Cellular angiofibroma is a rare benign mesenchymal tumor which mostly located at superficial soft tissue of the genital region. The first description of this tumor by Nucci et al. article in 1997. It could occurs in both genders, respectively. Clinically, it can easily be mistaken for a sliding or scrotal hernia. Cellular AF may be difficult to distinguish from other tumors of genital area based on the radiological findings. Thus, the differential diagnosis includes tumors of Schwann cells, perineuromas, spindle cell lipomas, aggressive angiomyxomas, solitary fibrous tumors, spindle-cell liposarcomas, and leiomyomas. Surgical resection is a treatment of choice. Macroscopically, the lesion is commonly well circumscribed, localized in the superficial soft tissue. Up-to-date the follow up clinical data for cellular AF is limited.

Cellular angiofibroma can be easily confused with hernia as its location at inguinal area or scrotum. However, it is a benign neoplasm which rich in fibroblast and vascular.