A giant soft tissue lesion of the male perineum: Unusual presentation of a cellular angiofibroma

Cellular angiofibromas (CAF) are rare, benign, soft tissue/stromal lesions first described by Nucci et al. in 1997. These masses are well circumscribed, typically small (< 6 cm), and occur mainly in the vulvar region in women and the inguinoscrotal region in men. We present a case of a 60-year-old male who was found to have a very large (20 cm × 13.5 cm × 6 cm) lesion occupying the deep pelvis bridging the pelvic outlet and involving the perineum. Because of diagnostic uncertainty and significant symptomatology, the mass was ultimately resected en bloc with the rectum and anus. Final pathology revealed a large multi-lobulated CAF. This tumor is the largest CAF reported in the literature to date. Furthermore, this mass involved the deep male pelvis with extension between two anatomic compartments which has not been previously described.