Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 102934

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : November | Volume : 5 | Issue : 6 | Page : 1241 - 1246 Full Version

Vascular Tumours of the Female Genital Tract: A Clinicopathologic Study of 11 Cases

Published: November 1, 2011 | DOI:
Uma S. Andola, Sainath K. Andola

MD, DCP, FICP, FIAMS, Professor and HOD, Department of pathology, Mahadevappa Rampure Medical College, Gulbarga, Karnataka-585105 (INDIA). MD, DNB, Associate Professor, Department of Obstetrics and Gynaecology, Mahadevappa Rampure Medical College, Gulbarga, Karnataka-585105 (INDIA).

Correspondence Address :
Sainath K. Andola
Professor and HOD, Dept of pathology, MR Medical College,
Gulbarga, Karnataka – 585105 (INDIA)
Phone: 08472-222948; Fax – 08472-225085


Introduction: Vascular tumours of the female genital tract (FGT) are very rare. The aim of this study was to analyze the distribution of vascular tumours in FGT and to correlate their clinicopathological features.

Materials and Methods:In a retrospective study of ten years, clinical features including imaging studies, gross and microscopic features of eleven cases of benign vascular tumours of FGT were reviewed. The age range in the present study was 22 to 95 yrs. The presenting complaint was abdominal pain/mass, postcoital bleeding, vaginal and vulval mass. The duration of symptoms varied from 3 months to 10 yrs. A diagnosis of vascular tumour was not considered in any of these on clinical grounds.

Results: The vascular tumours occurred most commonly in ovary (five), followed by vulva (three), and one each in cervix, vagina and placenta. Clinical diagnoses ranged from cystadenoma in ovaries to endocervical polyp in cervix, Bartholin’s cyst in vulva and carcinoma in vagina. Histologically all were benign vascular neoplasms, ranging from hemangioma (five), lymphangioma (two), lymphangioma circumscriptum (one) and chorangioma (one). Two recently described very rare vulval soft tissue tumours angiomyofibroblastoma (one) and aggressive angiomyxoma of the vulva (one) were also encountered.

Conclusions: Thus we conclude that benign vascular tumours in the FGT can present with symptoms similar to gynaecological tumours & epithelial malignancies and may lead to unwarranted radical surgery. Pathological examination is necessary in all such cases to exclude the possibility of malignancy. Angiomyofibroblastoma and aggressive angiomyxoma of the vulva are very rare and both shared similar clinical and histopathologic features causing diagnostic problems.


Female genital tract, Vascular tumours, Haemangioma, Lymphangioma, Angiomyofibroblastoma, Aggressive angiomyxoma, chorangioma, Lymphangioma circumscriptum

Vascular tumours are rarely found in the female genital tract (FGT). The ovaries have a rich vascular supply and the rarity of vascular tumours in the ovary is therefore surprising (1). It has been postulated that the rarity of this tumour is due to the cyclic changes that the ovary undergoes during the reproductive years (2). Most of the vascular tumours are incidental findings due to their small size and asymptomatic nature (3),(4).However, large lesions are present clinically, with features mimicking the common gynaecological tumours, even on ultra-sonographic examination. Most of the literature contains the short series of these tumours which are confined to one organ of the FGT (1), (3), (4). The objective of the present study was to describe the clinical profile and the pathological features of eleven cases of benign vascular tumours of the FGT.

Material and Methods

All the cases which were diagnosed as having vascular tumour of the FGT in the Department of Obstetrics and Gynaecology and Pathology during a period of ten years from 2000–2009, were retrieved. The clinical features, the imaging studies and the gross findings were analyzed and the microscopic slides were reviewed for the histopathological features.


The clinical features and the physical examination findings are presented in (Table/Fig 1). The ages of the patients ranged from 22 to 95 years (the mean was 45.5 years). The duration of thesymptoms varied between three months to ten years. Five patients had tumours in the ovary (three left, one right, one bilateral), four in the vulva and one each in the cervix and the vagina (Table/Fig 2). These cases presented with non-specific symptoms which ranged from abdominal masses and/or pain, post coital bleeding and vaginal and vulval masses. A diagnosis of vascular tumour was not considered in any of these cases on clinical grounds.

The clinical differential diagnosis in the present series included tubo-ovarian masses (cases1, 2, 10), haemorrhagic cyst (case 8), endo-cervical polyp (case-5), Ca Vagina (case 6) Ca Cervix with metastasis (case-4) and Bartholin’s cysts (cases 7, 9). The bilateral ovarian tumour in Case-4 was an incidental finding in the pan-hysterectomy specimen in a case which was diagnosed as carcinoma of the cervix. The vulval lesions in cases 7 and 9, were clinically thought to be Bartholin’s cyst. In case 10, the USG report was acute appendicitis with a bulky uterus and an enlarged right ovary, with a clinical diagnosis of acute appendicitis.

The USG in three cases with ovarian tumour showed a cystic ovarian mass with variable echogenecity. The imaging reports of the other cases were not available for review. In case 4, the USG reports suggested an enlargement of both the ovaries, probably because of metastasis. The anatomic distribution of the tumours is shown in (Table/Fig 2).

Three patients with ovarian tumours underwent total abdominal hysterectomy with salphingo-opherectomy. In one case, pan hysterectomy with excision of the bilateral pelvic lymph nodes wasdone. In case 2, left side salphingo-opherectomy was done. Endocervical polypectomy was done in case 5 and excision of the mass (vagina) was done in case 6. In cases 7 and 9, the vulval masses were excised completely. In cases 3 and 11, excision was done. In case 10, appendicectomy was done along with hysterectomy.

The gross and microscopic features are summarized in (Table/Fig 3).

Three cases with ovarian tumours showed variably enlarged ovaries with a honey-comb appearance on cut-section, with dark brown areas. Microscopy revealed cavernous hemangioma. In Cases 2 and 10, the ovaries were enlarged and the cut-section showed multiple cystic areas and solid areas. Microscopy showed numerous dilated lymphatic spaces which were filled with lymph fluid and lymphocytic infiltrates and a diagnosis of lymphangioma was made. The cervical lesion in case 5 was received as a cervical polyp which was haemorrhagic and microscopy revealed cavernous hemangioma. In case 6, the excision of the vaginal mass which was clinically suspected to be Ca Vagina, revealed cavernous hemangioma. The vulval lesions in cases 3 and 11, revealed the features of lymphangioma circumscriptum.

Case 7 had a mass in the labia for the past ten years and it was clinically diagnosed as Bartholin’s cyst. As the mass was progressively increasing in size, total excision was done and microscopyrevealed a tumour which consisted of alternate hypo and hyper cellular areas with numerous delicate capillary sized blood vessels which were lined by endothelial cells. The stromal cells were plump to spindle cells with a moderate amount of eosinophilic cytoplasm, having round to oval to spindly nuclei with fine chromatin and inconspicuous nucleoli. These cells were numerous in the hyper cellular areas and were clustered around the blood vessels. There was no atypia and no mitoses. A diagnosis of angiomyofibroblastoma of the vulva was made.

In case-9, a clinical diagnosis of Bartholin’s cyst was made and an excision was done. Grossly, it showed soft, gelatinous, reddish brown areas. Microscopically, the lesion was moderately cellular with predominant stellate cells and few spindle cells in an abundant myxomatous stroma. The stromal cells were bland oval and showed no atypia. Amidst these were seen numerous medium to large sized blood vessels with thickening of the walls and hyalinization. Plently of pigmented macrophages were present. A diagnosis of deep aggressive angiomyxoma of the vulva was made (Table/Fig 4),(Table/Fig 5),(Table/Fig 6),(Table/Fig 7),(Table/Fig 8),(Table/Fig 9).

In case 4, bilateral cavernous hemangioma was detected as an incidental finding during the procedure of pan-hysterectomy which was done in a diagnosed case of carcinoma of the cervix. Interestingly, in this patient, a small leiomyoma was present in the myometrium. The pelvic lymph nodes showed metastatic deposits. In addition, the lymph nodes showed a necrotizing, granulomatous inflammation which was compatible with tuberculous lymphadenitis. Both the ovaries were enlarged and showed features of cavernous hemangioma.

In all the eleven cases, there was no atypia, no mitosis and no necrosis.


Vascular tumours of the FGT, especially of the ovary, constitute a very small percentage of all the tumours of the FGT (4). There are only a few case reports and short series of these tumours in the literature (1),(4). Vascular tumours have been reported in a wide age group which ranged from 4 months to 81 years (4). In the present series, the ages of the patients ranged from 22 years to 95 years, with a mean age of 45.5 years. A majority of the patients were in the age group of 35-50 years (eight cases). There was no specific clinical presentation which was suggestive of vascular tumour, aswas noted in the present series. However, these tumours can mimic other common FGT neoplasms. Malignancy was highly suspected in one case (case 6).

Hemangioma of the Ovary
Hemangioma of the ovary was first described by Payne in 1869.2 Ovarian hemangiomas are commonly discovered incidentally at autopsy or surgery. Sometimes they are present with an abdominal mass and/or pain and acute abdomen or ascites, simulating the commoner ovarian neoplasms (4). All the cases in the present series were symptomatic, except one (case 4), where pan hysterectomy was done in a case of primary cervical cancer which showed the incidental findings of bilateral ovarian hemangioma. Ovarian hemangiomas are usually unilateral, though bilateral cases have been reported (2). The present series also showed incidental findings of bilateral hemangioma of the ovary.

Ovarian hemangiomas are usually situated in the medulla and the hilus. The lesion has a smooth outer surface and is red or purplish on the cut surface. In contrast to the vascular tumours in other parts of the body, the most common histologic type which is found in the ovary is the cavernous or mixed cavernous-capillary type. In the present series, all the five cases were of the cavernous type. Both the cortex and the medulla of the ovaries were involved in allthe cases. The histopathological examination was diagnostic for the lesion.

The aetiology of ovarian hemangiomas is unknown. Some state that it is a true tumour or hamartoma or stimulated vessels. Though ovarian hemangiomas are non functional, however it is well known that leutinization of the ovarian stromal cells commonly occurs as a reactive phenomenon, and that it may be associated with androgenic, oestrogenic or progestrogenic effects (5),(6). In the present study of 2 cases, leutinization of the stroma was not observed .

The pre-operative diagnosis of ovarian hemangiomas may be facilitated by radiological methods, thus making it possible to avoid radical surgery (3). In the present series, four cases were diagnosed as ovarian cysts on ultrasound examination and they underwent radical surgery. Simple oophorectomy is curative for ovarian hemangioma (4). So, a clinicopathologic correlation is usually essential.

Lymphangioma of the Ovary
Lymphangioma of the ovary is extremely rare, with approximately 16 cases being reported in the English literature (4),(7),(8). In the present series, two cases of ovarian lymphangiomas were encountered. Clinically, they simulated other cystic tumours of the ovary, which were similar to hemangioma. Therefore, a pathological examinationis necessary to reach the correct diagnosis. A lymphangioma has to be differentiated from a teratoma by looking for a prominent vascular component, hemangioma and an adenomatoid tumour (7). The contents in the cystic spaces, the characteristic morphology with the lymphocytic infiltrates and immunohistochemistry may help in differentiating these conditions in the difficult cases (8).

Cervical Hemangioma
Fewer than 40 cases of hemangioma of the cervix have been reported in the literature (2),(4),(9). In the present study, one case of cavernous hemangioma of the cervix presented clinically with post coital bleeding and it was diagnosed as endocervical polyp on examination. Although cervical hemangiomas are generally asymptomatic, 35% of the reported cases were associated with abnormal vaginal bleeding. In one of the reported cases, there was rapid growth of the lesion during two pregnancies, necessitating a delivery by caesarean section (9).

Cavernous Hemangioma of the Vagina
Cavernous hemangioma of the vagina is extremely rare and no cases have been reported in the literature over the past 35 years. A case of vaginal cavernous hemangioma was described byBartsh in 1959 and a case of cavernous hemangioma during pregnancy was reported by F Rizwan in 1997 (10). Emoto et al noted a rapidly growing vaginal lymphangioma which was obliterated via arterial embolization. The present case was a 95 years old female who presented with a mass in the paraurethral region of the vagina, which bled on touch. It was clinically diagnosed as vaginal carcinoma and was excised. The mass was vascular, necrotic and friable, with a sessile base. Microscopically, the mass revealed a hyperplastic squamous epithelium with large dilated cavernous vascular channels which were lined by flattened endothelium and it was diagnosed as cavernous hemangioma of the vagina.

Lymphangioma Circumscriptum
Lymphangioma circumscriptum is characterized by clusters of thin walled vessels which are filled with a clear fluid (11). However, epithelial hyperplasia and hyperkeratosis give rise to firm lesions which are clinically suspected as genital warts or molluscum contagiosum. Lymphangioma circumscriptum may be congenital or acquired. To date, about 11 cases of congenital and 23 cases of acquired lymphangioma circumscriptum of the vulva have been reported in the English literature (4),(11),(12). The acquired cases are mostly seen after radiotherapy to the pelvis for carcinoma of the cervix and hence, the cases are diagnosed to exclude metastatic deposits. The two cases presented with small, nodular, warty/vesicular lesions in the labia without any previous history of malignancy. Excision biopsies of both the cases revealed the features of lymphangioma circumscriptum which was covered by hyperkeratotic, hyperplastic, squamous epithelium.

Angiomyofibroblastoma of the Vulva
Angiomyofibroblastoma is a rare, benign, mesenchymal tumour that occurs mainly in the vulval region of middle aged (35-45 years) women (13),(14). In 1992, Fletcher et al proposed that angiomyofibroblastoma was a clinicopathological entity which was based on the detailed observation of the vulval soft tissue tumours (13). Different studies have suggested that mesenchymal vulval tumours in women of the reproductive age group, like angiomyofibroblastomas, aggressive angiomyxomas, cellular angiofibromas, fibroepithelial stromal polyps and superficial angiomyxomas, probably arise from a common, pluripotential, primitive cell which is located around the vessels of the connective tissue, which could show the capacity for modulating its phenotypetowards similar but distinctive mature cells (15),(16). These can present diagnostic difficulties for pathologists because of their relative rarity and their overlapping morphological features.

There are only over 70 cases which have been reported in the English literature to date (16).

Angiomyofibroblastomas are well circumscribed and range from 0.5 to 12cm, but usually measure <5cm. They can be adequately treated by wide local excision (14),(15),(16). On histological examination, angiomyofibroblastomas have been found to be composed of alternating hypercellular and hypocellular oedematous areas in which numerous, thin walled, small to medium sized vessels are regularly distributed. The tumour cells which are described as stromal cells, have a spindle to rounded or epithelioid appearance. The tumour cells are characteristically aggregated around the vessels or are loosely dispersed in the hypocellular areas. Nuclear atypia and mitosis are not seen. The oedematous area typically contains wavy collagen fibres, but little or no mucin. The differentiation between angiomyofibroblastoma and aggressive angiomyxoma may be very difficult, both clinically and histologically (16).

In the present study, one case of angiomyofibroblastoma was diagnosed, which presented clinically as Bartholin’s cyst and was present for the past ten years. She came to the hospital because the mass was progressively increasing in size. Grossly, it was a globular, grey white mass which measured 7 x 6 x 5 cms. The cut section showed a well encapsulated, grey white, soft rubbery mass which was histologically diagnosed as angiomyofibroblastoma.

Aggressive Angiomyxoma of the Vulva
Aggressive angiomyxoma was first described by Steeper and Rosai in 1983 (17). This is a rare, locally infiltrative tumour that arises in the pelvic and perineal soft tissues of young women (17). Approximately 100 cases have been reported (16). Aggressive angiomyxoma has a high rate of local recurrence because of its infiltrative growth and anatomical location. The treatment of choice is wide local excision. The local recurrence rate is in the range of 50-70% as has been reported (17),(18).

Grossly, aggressive angiomyxoma is a non-encapsulated, gelatinous tumour with an infiltrative edge. The histological examination shows a hypocellular tumour with small ovoid, spindled or stellatecells which exhibit minimal nuclear atypia, if any. Mitotic figures are not common. Numerous blood vessels are present and they vary from thin walled capillary like vessels to large vessels with thick muscular walls (18). There is no specific immuno-histochemical marker for aggressive angiomyxomas as yet. The tumour cells uniformly express vimentin and they heterogeneously express muscle specific actin and desmin (15),(16).

Srinivasan R et al reported an aggressive angiomyxoma which presented as a vulval polyp (19). We also encountered a case of aggressive angiomyxoma in a 50 year old female, with the clinical presentation as Bartholin’s cyst. Grossly, it was a pedunculated mass which was covered with skin, which measured 6 x 4 cm, with a gelatinous cut section appearance. Based on the characteristic histological features, a diagnosis of deep aggressive angiomyxoma was made. There was no recurrence upto nine months of follow up.

The cases of angiomyofibroblastoma and aggressive angiomyxoma in the present series illustrated that the differential diagnosis could be difficult. The tumours were rather similar in clinical presentation as well as at surgery and on histopathologic examination. Both the cases presented as a soft non tender swelling in the vulva and were preoperatively diagnosed as Bartholin’s cyst. The atypical and diagnostically misleading clinical features were the large size of the angiomyofibroblastoma and the near absence of local infiltration of the aggressive angiomyxoma. Similar features were observed by Schotz et al. These tumours are so rare that many gynaecological surgeons will never see one (16).


The benign vascular tumours of the FGT present clinically, simulating the common gynaecological tumours; some are asymptomatic and are found incidentally. Vascular tumours, especially of the ovaries, are difficult to differentiate clinically and radiologically from other neoplastic conditions. Sometimes they may be present as an acute abdomen. A detailed clinicoradiological examination is needed to find the extent of the vascular lesion. A pathological examination is necessary in all such cases, to exclude a probability of malignant vascular tumours .Benign vascular tumours have to be differentiated from malignant vascular tumours like angiosarcoma which are rarer than the benign entities, with only a handful of cases being reported in the literature (4),(12). Angiomyofibroblastoma and aggressive angiomyxoma are very rare vulval mesenchymal tumours which share similar clinical and histopathological features which cause diagnostic problems. Surgical excision is curative in most of the cases and tumours like aggressive angiomyxomas are carefully followed up because of their common recurrence and local invasiveness.


Uppal S, Heller DS, Majmudar B. Ovarian hemangioma- Report of three cases and review of the literature. J Arch Gynecol Obstet. 2004; 270:1-5.
Talerman A. Hemangioma of the ovary and the uterine cervix. Obstet Gynaecol. 1967; 30(1):108-13.
Gerbie AB, Hirsch MR, Greene RR. Vascular tumours of the female genital tract. Obstet Gynaecol 1955; 6(5):499-507.
Gupta R, Singh S, Nigam S and Khurana N. Benign vascular tumours of the female genital tract. Int J Gynaecol Cancer 2006; 16(3):1195- 200.
Ahluwalia J, Girish V, Saha S, Dey P. Lymphangioma of the ovary. Acta Obstet Gynaecol Scand 2000; 79(10):894-5.
Evans A, Lytwyn A, Urbach G, Chapman W. Bilateral lymphangiomas of the ovary: an immunohistochemical characterization and review ofthe literature. Int J Gynaecol Pathol. 1999; 18(1):87-90
Cherkis RC, Kamath CP. Hemangioma of the uterine cervix and pregnancy: a case report. J Reprod Med. 1988; 33(4):393-5.
Rezvani FF. Vaginal cavernous hemangioma in pregnancy. Obstet Gynaecol. 1997; 89(5 Pt 2):824-5.
Vlastos AT, Malpica A, Follen M. Lymphangioma circumscriptum of the vulva: a review of the literature. Obstet Gynecol. 2003; 101(5 Pt 1):946-54.
Kondi-Pafiti A, Kairi-Vassilatou E, Spanidou-Carvouni H, Kontogianni K, Dimopoulou K, Goula K et al. Vascular tumours of the female genital tract: a clinicopathologic study of nine cases. Eur J Gynaecol Oncol 2003; 24(1):48-50.
Fletcher CDM, Tsang WY , Fischer C. Angiomyofibroblastoma of the vulva. Am Surg Path. 1992;16:373–82.
Fukunaga M, Nomura K, Matsumoto K, Doi K, Endo Y, Ushigome S et al. Vulval angiomyofibroblastoma: Clinicopathologic analysis of six cases. Am J Clin Pathol. 1997; 107(1):45-51.
Ducarme G, Valentin M, Davitian C, Felce-Dachez M, Luton D. Angiomyofibroblastoma: a rare vulvar tumour. Arch Gynaecol Obstet. 2010; 281:161-2.
Schiotz HA, Myhr SS, Chan KF, Klingen TA. Angiomyofibroblastoma and aggressive angiomyxoma: two rare tumours of the vulva. J Pelvic Med Surg. 2006; 12(4):225-8.
Steeper TA, Rosai J. Aggressive angiomyxoma of the female pelvis and the perineum. Report of nine cases of a distinctive type of gynaecologic soft-tissue neoplasm. Am J Surg Pathol. 1983; 7(5):463-75.
Begin LR, Clement PB, Kirk ME, Jothy S, McCaughey WT, Ferenczy A et al. Aggressive angiomyxoma of the pelvic soft parts: A clinicopathologic study of nine cases. Human Pathol. 1985; 16(6):621-8.
Srinivasan R, Mohapatra N, Malhotra S, Rao SK. Aggressive angiomyxoma presenting as a vulval polyp. Ind J Cancer 2007; 44(2):87-9.
Yamawaki T, Hirai Y, Takeshima N, Hasumi K. Ovarian haemangioma which is associated with concomitant stromal luteinization and ascitis. Gynaecol Oncol 1996; 61:438-41.
Savargaonkar PR, Wells S, Graham I, Buckley CH. Ovarian hemangiomas and stromal luteinization. Histopathology 1994; 25:185-8.

DOI and Others


JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)