Vulvar Aggressive Angiomyxoma in a Postmenopausal Woman: Diagnostic Pitfalls and Surgical Implications-A Case Report.

BACKGROUND: Vulvar aggressive angiomyxoma (VAAM) is a rare, benign mesenchymal tumor with a deceptively indolent histology but locally infiltrative growth and a high risk of recurrence, typically within 3 years and occasionally more than a decade after excision. Its occurrence in postmenopausal women is exceptionally rare, often leading to delayed diagnosis and posing unique surgical challenges.

CASE PRESENTATION: We report the case of a 45-year-old postmenopausal Ethiopian woman presenting with an 8 × 6-cm vulvar mass initially misdiagnosed as a lipoma based on clinical findings. Absence of preoperative imaging or tissue sampling contributed to underestimation of tumor extent. Intraoperatively, the lesion demonstrated nonencapsulated infiltrative extension into deep paravaginal tissues, prompting intraoperative multidisciplinary consultation and conversion to exploratory laparotomy to exclude retroperitoneal or intrabdominal involvement. Complete wide-margin excision was not feasible due to deep infiltration and proximity to critical neurovascular structures; therefore, maximal resection was performed. Histopathological examination confirmed aggressive angiomyxoma. At 12 months' follow-up, no clinical recurrence was detected; however, long-term surveillance is ongoing.

CONCLUSION: VAAM is a rare yet clinically demanding tumor that poses significant diagnostic and surgical challenges, particularly in postmenopausal women and resource-limited settings. This case establishes the central role of preoperative imaging in precise tumor delineation, confirms the definitive diagnostic value of histopathological evaluation, affirms the importance of intraoperative adaptability, and supports the integration of structured, long-term surveillance to optimize early detection of recurrence.