Conservative en bloc surgery for aggressive angiomyxoma achieves good local control; Analysis of 14 patients from a single institution

Background: The purpose of this study was to assess the value of conservative surgery in aggressive angiomyxoma (AA) in our institutional series. Method: This was a retrospective review of patients with AA treated at our institution between 1999 and 2010. Results: Fourteen consecutive patients were analyzed: 8 primary tumors and 6 recurrences. Female/male ratio was 13:1; median female age was 36 years. Median size of primary lesions was 12 cm(range, 7Y17cm).Median size of recurrenceswas 20.5cm(range, 3Y44cm).Twelve patients were operated on. Two asymptomatic patients whose surgery would have been mutilating were placed under wait and see. Four patients had concomitant visceral resections because of massive infiltration. No tumor rupture was recorded on pathological examination. Margins were R0 (n = 2), R1 (n = 10), and R2 (n = 0). Seven patients (50%) received radiotherapy. Median postoperative follow-up was 69 months, and no patient was lost at follow-up. All patients operated on (primaries and recurrences) had no evidence of recurrence. Conclusion: Conservative and planned en bloc surgery achieves good local control with low morbidity. Radiotherapy could enhance local control in advanced disease. Wait and see is an exploratory option for asymptomatic, stable, and nonprogressing AA in which surgery would be mutilating.