Definitive Radiotherapy for Vaginal Angiomyofibroblastoma

Angiomyofibroblastoma (AMF) is a rare, benign, mesenchymal tumour occurring mainly in the vulva region of women. These tumours occur primarily on vagina, vulva, perineum, uterine cervix and the inguinoscrotal regions of men. There are only few cases described with primary occurrence in the pelvis or retroperitoneum. The goal of management is complete resection of tumour, but incomplete or partial resection is acceptable, especially when high operative morbidity due to extensive surgery is anticipated and preservation of fertility is an issue. Most of these tumours show oestrogen and progesterone receptor positivity and are likely to be hormone dependent. Several beneficial results with gonadotropin-releasing hormone (GnRH) agonist have been described in primary treatment of small tumours, as adjuvant therapy for residual tumour, pre-operatively to shrink tumours or even in the treatment of recurrence. However, there are no conclusive data as to the effectiveness of hormonal therapy/ oopherectectomy in the treatment of these tumours. There are no supporting data for use of chemotherapy in patients with AMF. Radiotherapy may be good alternative to surgery, for unresectable, medically inoperable or recurrent tumours, and also patients unresponsive to embolization or hormonal therapy requiring morbid surgery. This case report describes the unique role of definitive radiotherapy for recurrent unresectable angiomyofibroblastoma of vagina in a young woman, and remains complete response for 20 months. We emphasize the role of definitive radiotherapy for patients with angiomyofibroblastoma of vagina and other pelvic sites that are not amenable for surgery, with benefits of good local control and organ preservation.