Cervical angiofibroma of soft tissue: A rare case report with literature review

Rationale: Angiofibroma of soft tissue (AFST) is a rare benign fibrous tumor recently included in the 2020 WHO classification of soft tissue and bone tumors. Currently, there are limited reports on AFST, and pathologists lack sufficient understanding of its clinical and pathological characteristics. There is scarce literature available on AFST in the cervical region. Patient concerns: We presented a case of a 49-year-old woman who was admitted to our hospital for emergency treatment due to vaginal bleeding and fatigue. Ultrasound revealed a 63 x 27 mm hypoechoic mass extending from the cervical opening to the external opening, with a hemoglobin level of 58.0 g/L on blood routine. Diagnoses: The tissue exhibited a pale-yellow mucinous appearance with distinct tissue boundaries and a fibrous capsule under a microscope. HE staining revealed spindle-shaped fibroblast-like cells with a consistent morphology, thin-walled branching small blood vessels, and dilated blood vessels. Regions with abundant cells and areas with sparse cells were alternately distributed and migrated gradually. Immunohistochemical analysis indicated positive expression of P53, desmin, progesterone receptor, estrogen receptor, epithelial membrane antigen, vimentin, CD68, CD163 in the tumor, but negative expression of P16, S-100, smooth muscle actin, CD117, CD10, STAT-6. CD34 was negative in the tumor cells but positive in the vascular endothelium. The Ki-67 index value was 5%. Pathological examination confirmed a soft tissue angiofibroma of the cervix. Interventions: Emergency hysteroscopic surgery was performed following infusion of 3 units of packed red blood cells. A local excision of the cervical mass was performed. Outcomes: A 1-month follow-up ultrasound showed no abnormal mass in the cervical canal, and there have been no signs of recurrence to date. Lessons: Cervical angiofibroma of soft tissue is a rare tumor with a benign clinical manifestation, minimal local recurrence, and no significant metastatic potential. Treatment primarily involves local resection with a focus on achieving negative surgical margins. By presenting this case, we aim to enhance the diagnostic and differential diagnostic capabilities of pathologists in identifying uterine tumors and preventing misdiagnosis.