Scrotal aggressive angiomyxoma mimicking inguinal hernia

Dear Sir,I am Yao-Chou Tsai, from Department of Urology,Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei,Taiwan, China. I write to you to present a case report ofscrotal aggressive angiomyoma.Aggressive angiomyxoma (AAM) is a rare, locallyinfiltrative mesenchymal benign neoplasm with a predi-lection for involving the female pelvis, perineum, vaginaand cervix. Its occurrence in men is much less frequentand only scattered case reports have been reported. Toour knowledge, only 43 cases of AAM occurring in menhave been reported in the English-language literature [1].AAM in the male inguinal area can present as an inguinalmass that is usually diagnosed and treated as inguinalhernia [2, 3]. Herein, we report an unusual case of a 40-year-old man with an AAM involving the scrotum, whounderwent a herniorrhaphy at a prior hospital. The AAMwas not removed. To our knowledge, this is the firstdocumented case in which scrotal AAM was missedduring surgical exploration for inguinal hernia.A 40-year-old man complained of a right scrotal mass,which had grown slowly over the previous10 years. Nolocal pain or urinary tract symptoms were noted. Thescrotal mass was initially diagnosed as an inguinal herniaand a herniorrhaphy was performed at a prior hospital.However, the scrotal mass still remained