Aggressive angiomyxoma of the vulva

A 33-year-old nulliparous women presented with a 4-week history of a painful vaginal swelling. There had been no relevant medical or gynaecological history of note and she was using the combined oral contraceptive pill (Cilest, Janssen-Cilag, High Wycombe, Bucks) for contraception. On pelvic examination, she had a tender right labial swelling 3×3×2 cm in size. The surrounding area showed no evidence of inflammation. Systemic examination was unremarkable. The clinical diagnosis made was of a right Bartholin cyst. At examination under anaesthesia and excisional biopsy, the lesion appeared to be a cystic, fleshy-looking lesion located on the right labia majora, but was also seen to be extending towards the right ischiorectal fossa. The area was excised and multiple grey fragments (the largest being 110×45×20 mm) were submitted for pathological examination. The lesion was well sampled and consisted of a mass of rather featureless spindled and stellate cells set in a myxoid and fibrillary background. It was hi...