Case Report of an Aggressive Angiomyxoma Presenting as Pelvic Organ Prolapse.

Aggressive angiomyxoma (AAM) is a rare, slow-growing, locally infiltrative mesenchymal tumor of the pelvis and perineum, most often affecting women. Its nonspecific presentation and tendency to mimic more common vaginal or periurethral masses frequently delay diagnosis. Early recognition is critical to guide appropriate surgical planning, optimize resection, and reduce recurrence risk. In this case, a 61-year-old woman with prior vaginal hysterectomy presented with symptoms of pelvic organ prolapse, urinary incontinence, and occasional bleeding. Examination revealed a 10 × 3-cm protruding anterior vaginal wall mass with a spongy texture. MRI demonstrated a well-defined tubular lesion in the left distal vaginal wall extending towards the vulva. Intraoperative evaluation, including cystourethroscopy, diagnostic laparoscopy, and general surgery consultation, ruled out bowel involvement. The mass was excised via vaginal approach with preservation of surrounding structures. Histopathology confirmed AAM. Margins could not be assessed due to specimen disruption. At 6-week follow-up, the patient was asymptomatic with well-healed incisions, and ongoing surveillance with gynecologic oncology was arranged. This case highlights the importance of including AAM in the differential diagnosis of anterior vaginal wall masses. Multidisciplinary collaboration and advanced imaging are essential for accurate diagnosis and surgical planning. Given the tumor's locally infiltrative nature and high recurrence rate, long-term follow-up is warranted. Awareness of this rare pathology can aid timely recognition and improve patient outcomes.