Recurrent aggressive angiomyxoma presented with perianal mass and typical imaging swirl sign

INTRODUCTION: Aggressive angiomyxoma is a rare pelvic neoplasm that arises commonly in middle aged women and usually has delayed presentation due to its typically silent and slow growing behavior. CLINICAL PRESENTATION: A 47-year-old woman presented at our hospital with recurrent attacks of pelvic pain and a perianal bulge. Her past medical history was relevant due to previous en bloc resection of a right ovarian angiomyxoma. Current cross sectional imaging, including computed tomography and magnetic resonance imaging, was performed and showed evidence of local recurrence. Various available treatment options were offered to the patient. DISCUSSION: The imaging features of the aggressive angiomyxoma were peculiar and showed a swirl and lamellate appearance in T1 and T2 weighted images. CONCLUSION: A locally aggressive tumor with benign histopathology and swirl sign in imaging is highly suggestive of aggressive angiomyxoma.