Vaginal Angiolipoleiomyoma: A Case Report and Literature Review.

Angiolipoleiomyoma (ALLM) is a rare benign mesenchymal tumor consisting of mature adipose tissue, smooth muscle, and thick-walled blood vessels. Its occurrence in the female genital tract is uncommon, and vaginal involvement is exceptionally rare, making preoperative diagnosis particularly challenging due to its non-specific clinical and imaging features. In this report, we present the case of a 45-year-old woman with a two-year history of progressive vaginal foreign body sensation accompanied by chronic constipation. Pelvic magnetic resonance imaging revealed a large mass measuring 13 × 9 × 8 cm in the rectouterine space, with superior displacement of the uterus. The patient underwent a total abdominal hysterectomy followed by a complementary vaginal resection of a tumor that was independent of the uterus. Histopathological examination revealed mature adipocytes, smooth muscle bundles, and thick-walled blood vessels. Immunohistochemical analysis showed positivity for desmin, smooth muscle actin, and CD34, and negativity for HMB-45. This confirmed the diagnosis of ALLM. The postoperative course was uneventful, with no recurrence observed at one-year follow-up. A literature review identified 47 publications comprising 68 reported cases of ALLM or extrarenal angiomyolipoma (AML) in the female genital tract, highlighting the extreme rarity of vaginal involvement. This case underscores the diagnostic challenges associated with this entity and emphasizes the importance of histopathological and immunohistochemical evaluation in distinguishing it from other mesenchymal tumors.