Radical resection of a pelvic angiomyxoma guided by 3D reconstruction: a two-stage approach – a case report
Julio E. Hernández Ug, Sylwia Bilas Sudol, Celia Aguilar Martínez, José J. Pozo Kreilinger, José T. Borjas Gómez, María I. Prieto NietoIntroduction:
Aggressive angiomyxoma is a rare, locally infiltrative mesenchymal tumor that predominantly affects women and occurs only exceptionally in men. Surgical management of large pelvic lesions is technically challenging because of the complex anatomy and close relationship to critical adjacent structures. Three-dimensional reconstruction may improve preoperative planning and intraoperative orientation in such cases.
Case presentation:
A 58-year-old man presented with a large pelvic mass diagnosed as an aggressive angiomyxoma. The preoperative assessment included computed tomography (CT) and magnetic resonance imaging (MRI), followed by patient-specific three-dimensional reconstruction based on CT-MRI fusion. This approach enabled detailed anatomical visualization and precise planning of the surgical strategy, including the determination of the level of sacrectomy.
Results:
Radical en bloc resection was performed using a two-stage approach, combining a prone position for partial sacrectomy and a supine position for abdominoperineal resection. The three-dimensional model facilitated the identification of tumor boundaries, spatial relationships, and critical vascular structures, allowing anticipation of the most technically demanding steps. Complete resection with negative margins was achieved. The postoperative course was uneventful, and the patient was discharged on postoperative day 10. No recurrence has been observed to date.
Conclusion:
Aggressive angiomyxoma of the pelvis in male patients requires an individualized, multidisciplinary approach. Three-dimensional reconstruction is a valuable tool for surgical planning in complex pelvic tumors, improving anatomical understanding and facilitating safe resection with negative margins.